Chapter 49: Assessment and Management of Patients with Hepatic Disorders, Cancer questions, theories 3 test 5

cirrhosis of the liver

A severe medical condition where scar tissue in the liver replaces functional tissue.

A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply. A) Immunization B) Use of standard precautions C) Consumption of a vitamin-rich diet D) Annual vitamin K injections E) Annual vitamin B12 injections

A) Immunization B) Use of standard precautions

tertiary prevention

monitoring and preventing of recurrent of the primary cancer assessing for development of second malignancies

Hyperthyroidism symptoms

nervous, hyperactive, emotional, mental changes, heat intolerance, weight loss, exophthalmos (with graves)

A military client reports to the clinic and tells the nurse of an increase in drinking since being in the service. How should the nurse respond? "There is no relationship between drinking while in active duty and when retired." "It is unlikely that you have a genetic predisposition to alcohol use." "Alcohol use in the military is higher than in the general population." "Drinking while in active duty translates to an increase in drinking once retired."

"Alcohol use in the military is higher than in the general population." Explanation: Research indicates that even though the rate of substance use disorders in the active military is low, there is increased use of alcohol and binge drinking when compared to the general population. Drinking while in active duty does not correlate with an increase in drinking once retired. In terms of alcoholism, there is evidence of a genetic input, but it does not correlate to military service. The probability that a military individual will continue with a substance use problem is significantly higher than a non-veteran individual.

A nurse is caring for a client who is 1-day postoperative following a total laryngectomy and has begun a soft diet. The client is not eating well and tells the nurse that the hospital food has no taste. Which of the following responses is appropriate for the nurse to make?

"Because of your surgery, you have an altered ability to smell and taste." Answer Rationale: Clients who have lost their larynx commonly complain of poor ability to smell and taste. This is because they now breathe through the tracheal stoma, rather than the mouth and nose, which bypasses the location of the olfactory and gustatory nerve cells.

A nurse is caring for a client who is 1-day postoperative following a total laryngectomy and has begun a soft diet. The client is not eating well and tells the nurse that the hospital food has no taste. Which of the following responses is appropriate for the nurse to make?

"Because of your surgery, you have an altered ability to smell and taste." Answer Rationale: Clients who have lost their larynx commonly complain of poor ability to smell and taste. This is because they now breathe through the tracheal stoma, rather than the mouth and nose, which bypasses the location of the olfactory and gustatory nerve cells.

The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response? "Benign tumors invade surrounding tissue." "Benign tumors can spread from one place to another." "Benign tumors don't usually cause death." "Benign tumors grow very rapidly."

"Benign tumors don't usually cause death." Explanation: Benign tumors remain at their site of development. They may grow large, but their growth rate is slower than that of malignant tumors. They usually do not cause death unless their location impairs the function of a vital organ, such as the brain.

A client with a gastrointestinal condition asks why the mouth needs to be examined. Which response will the nurse make?

"Changes in the mouth can help explain why your condition is occurring." Explanation: A complete assessment of the oral cavity is essential because many disorders, such as cancer, diabetes, and immunosuppressive conditions resulting from medication therapy or acquired immunodeficiency syndrome, may be manifested by changes in the oral cavity, including stomatitis. Assessment of the mouth is not done because it is the body part least examined. It is not assessed because it is a part of every assessment. The nurse has no way of knowing if the client's gastrointestinal problem is in the client's mouth.

A nursing student needs clarification when overheard making which of the following statements? "Homeless people lack identification." "Homeless people lose the psychological sense of belonging." "Homeless people are people who only lose their houses." "Homeless people may not be able to keep relationships with friends and family."

"Homeless people are people who only lose their houses." Explanation: Homeless people incur losses far greater than that of a house; they also lose the psychological senses of belonging and home. Additional losses may include family ties, friends, work, health, and community support.

A nursing instructor is teaching students about vulnerable populations and lists homelessness as an example. Which of the following statements made by a student indicates a need for further instruction? "Homelessness can mean lacking a fixed permanent nighttime residence." "Homelessness can be not having a place to live." "Homelessness does not include those who live in shelters." "Homelessness is on the rise."

"Homelessness does not include those who live in shelters." Explanation: Homelessness is lacking a fixed permanent nighttime residence or living in nighttime residences that are temporary shelters, welfare hotels, transitional housing for the mentally ill, or any public or private place not designated as sleeping accommodations for human beings.

A psychiatric nurse is assessing a client with post-traumatic stress disorder (PTSD). During the psychosocial component of the assessment, what assessment question should the nurse include? "How are your symptoms affecting your day-to-day routines?" "Have you been having any side effects from your medication?" "Do you feel like treatment has been beneficial so far?" "How would describe the quality of your sleep these days?"

"How are your symptoms affecting your day-to-day routines?" Explanation: Assessing the effect of a client's PTSD on his or her daily routines is a major focus of psychosocial assessment. Sleep is a component of a physical assessment, as are medication side effects. Eliciting the client's opinion of treatment so far is important, but this is not situated solely within the psychosocial domain.

The nurse is preparing a client for magnetic resonance imaging (MRI) of the abdomen. Which statement by the client would indicate the need to notify the physician?

"I really don't like to be in small, enclosed spaces." Explanation: An MRI scanner is a narrow, tunnel-like machine that will enclose the client during the test. Clients who are claustrophobic (fear enclosed spaces) may need sedation because it is imperative that they lie still and not panic during the test. Therefore, the nurse should notify the physician about the client's statement. Typically, the client is NPO for 6 to 8 hours before the test, and he or she must remove any metal objects, credit cards, jewelry, and watch before the test. Visualization will assist the client in relaxing during the procedure.

The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include?

"How often do you drink alcohol?" Explanation: The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important. Asking about an infection or exposure to hepatotoxins or industrial chemicals would be important if the client had postnecrotic cirrhosis.

A nurse is completing a physical assessment of a homeless, mentally ill client. The client is experiencing delusions. What response by the nurse reflects thereaputic communication while completeing the physical assessment? Select all that apply. "I am going to close the door to provide some privacy." "I am not sure why you are even here." "Let me know if you do not understand what I am explaining to you." "Stop me if you think of something to ask." "Outside the room, other clients are waiting."

"I am going to close the door to provide some privacy." "Let me know if you do not understand what I am explaining to you." "Stop me if you think of something to ask." Explanation: Communication techniques of a homeless client's physical assessment should focus on privacy and a non-hurried approach. The nurse should be respectful and allow for interruptions from the client-centered interaction. The nurse should explain the various elements of the physical exam.

A nurse is providing care to a client who has a history of homelessness. Which statements by the client identify stressors that affect homelessness? Select all that apply. "Do you think you can help me?" "Nothing matters." "I am overwhelmed and do not care about anything." "I am trying to change things."

"I am overwhelmed and do not care about anything." "Nothing matters." Explanation: Persons who have been or are homeless and have mental illnesses have typically have endured and coped with constraints or problems with extremes stressors or catastrophes and negative life events. The nurse needs to recognize how the client is feeling and attempt to instill a sense of hope and recovery from homelessness and mental illness. "I am overwhelmed" and "nothing matters" are statements that the client has had extreme stressors affecting coping. The nurse should recognize these as challenges.

The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? "The doctor will remove cells from my bone marrow before beginning chemotherapy." "I will need to attend follow-up visits for up to 3 months after treatment." "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." "I hope they find a bone marrow donor who matches."

"I hope they find a bone marrow donor who matches." Explanation: An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months, but not in protective isolation.

indication of extravasation during administration of vesicant medications

- absence of blood return from IV catheter - resistance to the flow of IV fluid - burning, pain, swelling, redness at site

A client is scheduled for an ultrasound of the abdomen. Which statement indicates that teaching provided to the client to prepare for the test was effective?

"I will not eat or drink for 8 to 12 hours before the test." Explanation: Ultrasonography is a noninvasive diagnostic technique in which high-frequency sound waves are passed into internal body structures, and the ultrasonic echoes are recorded on an oscilloscope as they strike tissues of different densities. It is particularly useful in the detection of an enlarged gallbladder or pancreas, or the presence of gallstones, an enlarged ovary, an ectopic pregnancy, or appendicitis. The client should be instructed to fast for 8 to 12 hours before the test to decrease the amount of gas in the bowel. Enemas are not needed before an abdominal ultrasound. A clear liquid diet is not needed before the test. Medications to reduce gastric acid are not required before the test.

A nurse is providing teaching to a client who has breast cancer about the adverse effects of chemotherapy. Which of the following client statements indicates an understanding of the teaching?

"I'll call my doctor if I notice any unusual menstrual bleeding."

A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching? "I'll use hats to protect my head from the sun when my hair falls out." "If I get nauseous, I'll try to eat several small, bland meals each day." "Most of the adverse effects should go away shortly after my last radiation treatment." "I'll allow myself plenty of time to rest between activities."

"I'll use hats to protect my head from the sun when my hair falls out." Explanation: The client requires additional teaching if he mentions that he will lose the hair on his head as a result of radiation therapy. Alopecia is an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of his lungs, not his head. Nausea and fatigue are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete.

A client with post-traumatic stress disorder has recently been prescribed prazosin. What statement by the client would most clearly suggest that the medication is having the desired effect? "My wife says that I'm a lot more emotionally available these days." "I haven't had any flashbacks since last week." "I think that I'm being a lot more patient with my kids lately." "I'm sleeping better than I have for many months."

"I'm sleeping better than I have for many months." Explanation: Prazosin is used to relieve the sleep disturbances and nightmares that accompany PTSD. It does not directly affect mood or flashbacks.

The nurse is interviewing the client with posttraumatic stress disorder (PTSD) about sleep patterns. Which statement(s) by the client would indicate to the nurse that the client is experiencing hyperarousal? Select all that apply. "Before I can even lay down, I have to triple-check that everything in my room is secure and safe." "If it's impossible for me to sleep, I sometimes drink until I pass out." "I get extremely angry, and often scream at people for the smallest thing if I don't sleep." "The smallest noise sets me on edge when I'm trying to sleep." "I lay awake at night, worried that something terrible will happen again."

"If it's impossible for me to sleep, I sometimes drink until I pass out." "I get extremely angry, and often scream at people for the smallest thing if I don't sleep." Explanation: The statements, "If it's impossible for me to sleep, I sometimes drink until I pass out," and, "I get extremely angry, and often scream at people for the smallest thing if I don't sleep," are both examples of hyperarousal. Hyperarousal is characterized by aggressive, reckless, or self-destructive behavior. The statements, "I lay awake at night, worried that something terrible will happen again," "Before I can even lay down, I have to triple-check that everything in my room is secure and safe," and, "The smallest noise sets me on edge when I'm trying to sleep," are all examples of hypervigilance, not hyperarousal.

A client asks the nurse why the physician ordered the blood test carcinoembryonic antigen (CEA). The nurse answers:

"It indicates if a cancer is present." Explanation: The carcinoembryonic antigen (CEA) blood test detects the presence of cancer by identifying the presence of a protein not normally detected in the blood of a healthy person. However, it does not indicate what type of cancer is present nor does it detect the functionality of the liver.

A nurse is caring for a client who is 9 days postoperative following a total laryngectomy. The nurse removes the client's NG tube and initiates oral feedings. Which of the following statements should the nurse make?

"It is no longer possible for you to choke on or aspirate food." Answer Rationale: The surgical procedure of total laryngectomy provides complete anatomical separation of the trachea and esophagus. Choking and aspiration of food and liquids is no longer possible

what to do if there is extravasation of chemo

- access the extravasatiuon kit (this should be readily available with emergency equipment and antidote meds, along w a quick reference on how to manage extravasation of the specific vesicant) - bring it up with the provider promptly so corrective measures can be implemented quickly to minimize local tissue damage - evaluate the patient receiving neurotoxic chemo - provide education to pt and family - make appropriate referrals for complete neuro evaluation and occupational or rehabilitative therapies

While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse about the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct?

"Malignant cells reproduce more rapidly than normal cells"

The nurse is working with a client who is suspected of having posttraumatic stress disorder after witnessing a violent crime. What statement by the client's spouse would suggest that the client is experiencing hyperarousal? "My spouse always seems so irritated now, which isn't like my spouse." "My spouse seems to sleep and sleep, even when there's no reason why my spouse should be tired." "My spouse's libido has completely dropped off, and that's not at all like my spouse." "My spouse seems to overeat at almost every meal, and then snack all the time too."

"My spouse always seems so irritated now, which isn't like my spouse." Explanation: Irritability is a hallmark of hyperarousal. Overeating, loss of sexual interest, and hypersomnia are not associated with hyperarousal.

The nurse asks a client to point to where pain is felt. The client asks why this is important. What is the nurse's best response?

"Often the area of pain is referred from another area." Explanation: Pain can be a major symptom of disease. The location and distribution of pain can be referred from a different area. If a client points to an area of pain and has other symptoms associated with a certain disease, this is valuable information for treatment.

a nurse is caring for a client who has been diagnosed with end-stage liver cancer. which of the following responses is an indication the client is in the denial phase of the grief process? "The doctor has been so good to me. I know he has tried everything he can. It is just my time." "I can't believe the doctor graduated from medical school. He doesn't know a thing about treating cancer!" "The doctor says I only have a few months to live, but I know he is exaggerating to get me to take my medication." "Even though I am not hurting right now, I don't feel like I have the energy to get out of bed."

"The doctor says I only have a few months to live, but I know he is exaggerating to get me to take my medication." This client statement is an example of denial. The five stages of grief might not be experienced in order, and the length of each stage will vary from person to person. In the denial stage, clients have difficulty believing a terminal diagnosis or loss. In the anger stage, clients lash out at other people or things. In the bargaining stage, clients negotiate for more time or a cure. In the depression stage, clients are saddened over the inability to change the situation. In the acceptance stage, clients accept what is happening and plan for the future.

The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? "Clients with alopecia will have delay in grey hair." "New hair growth will return without any change to color or texture." "Wigs can be used after the chemotherapy is completed." "The hair loss is usually temporary."

"The hair loss is usually temporary." Explanation: Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan.

expected orders for acute diverticulitis

- administer ampicillin / sulbactam IV bolus - type and cross match blood - replace fluids and electrolytes with IVF - CT of the abdomen with contrast

primary aldosteronism causes

- adrenal gland tumors - ovarian tumors that secrete aldosterone - family history of aldosteronism

A client diagnosed with posttraumatic stress disorder (PTSD) has been encouraged to engage in exposure therapy. What statement(s) should a nurse provide to help the client prepare to effectively engage in this treatment? Select all that apply. "Therapy will teach how trauma has changed personally held thoughts and beliefs." "Writing down or journaling the details of the trauma will be therapeutic." "Therapy will help you reframe the traumatic experience in a more realistic manner." "Physically revisiting the site where the traumatic event will be helpful for you, when possible." "Therapy will help you face and control fear through controlled expose to the trauma."

"Therapy will help you face and control fear through controlled expose to the trauma." "Physically revisiting the site where the traumatic event will be helpful for you, when possible." "Writing down or journaling the details of the trauma will be therapeutic." Explanation: Psychotherapeutic approaches to the treatment of clients with PTSD include exposure therapy, which helps people face and control their fear by exposing them to the trauma in a safe way. Strategies include mental imagery, writing, or visits to the place where the event happened. Cognitive restructuring helps people make sense of the bad memories by reframing their experiences in a more realistic way. Cognitive processing therapy helps people understand how traumatic experiences changed thoughts and beliefs and influenced current feelings and behaviors.

A client who is a veteran from a foreign war routinely uses an opioid for pain management. Which question should the nurse ask during the assessment of this client? "Are you employed?" "How long were you deployed?" "Do you receive care at a VA hospital?" "Were you injured during the war?"

"Were you injured during the war?" Explanation: Opioid use in the military often begins with a prescription following an injury. Asking if the client was injured during the war would help determine the reason for the client to use an opioid for pain management. Asking about employment, deployment, or location for care would not help determine the reason for the client to use opioids.

The nurse is concerned that a veteran is at risk for suicide. Which question should the nurse ask that will determine if the client has access to firearms without violating the client's constitutional rights? "What do you have for personal protection from harm?" "Did you learn to use a firearm in the military?" "What's your opinion about gun control?" "How many guns do you have?"

"What do you have for personal protection from harm?" Explanation: The most common suicide method is firearms. Veterans have higher rates of firearm ownership than the general population and are at substantially increased risk of firearm suicide compared to non-veterans. Veterans use firearms mainly for personal protection. However, protection generally favors measures to restrict access to firearms among at-risk individuals. Providers are often hesitant to screen and counsel for firearms because of the lack of familiarity with guns, little confidence in intervention effectiveness, or philosophical reasoning related to constitutional rights. The question that would protect the client's rights would be to ask the general question, "What do you have for personal protection from harm." Asking about the number of guns, opinions about gun control, or learning to use a firearm in the military could be construed as intrusive or a violation of the client's rights.

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?

"You must have the second one in 1 month and the third in 6 months." Explanation: Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.

homelessness is more common in

- adult males - veterans - convicted criminals - SMI population - refugees / migrant workers / immigrants

The nurse is serving as the case manager for a homeless client with schizophrenia. Knowing the homeless face unique barriers to health maintenance, the most appropriate instruction from the nurse would be which of the following? "I know you don't have many financial resources. As long as you feel good you can skip some doses of medicine. Just be sure to resume it if you start having symptoms." "You don't need to come back to the clinic as long as you are not having any symptoms." "Whenever you need to come to the clinic just call a cab. They can pick you up wherever you are." "You need to return to the clinic each week to get your medicine and to make sure that it is working for you."

"You need to return to the clinic each week to get your medicine and to make sure that it is working for you." Explanation: Case management is the key intervention that connects the client with the community. The nurse case manager coordinates services to ensure that the client receives the structure and support needed to achieve and maintain optimal functioning. Case management encompasses health teaching, crisis intervention, symptom monitoring, assistance with federal or local entitlements, assistance with transportation, teaching about money management, and consumer advocacy.

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is "You will experience menopause now." "You will be unable to have children." "You will need to practice birth control measures." "You will continue having your menses every month."

"You will need to practice birth control measures." Explanation: Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? Select all that apply.

"chemo" gloves facemask isolation gown

diagnostics for hepatitis

- ALT - AST - ALP - Tbilirubin (elevated) - Positive hepatitis antibodies - liver biopsy

Cirrhosis treatment

- Assess for neuro, respiratory, cardiac, nutritional status - Diuretics, beta blockers, lactulose - Paracentesis, surgical shunts, liver transplant

treatment of cholecystitis

- Bile acids to break up stones (ursodiol) - Lithotripsy - cholecystectomy (may have drain)

Post Liver Transplant

- ICU patient monitor: VS neuro graft vs host infection monitoring clotting problems decreased bile drainage, RUQ pain with distension, N/V, AKI, meds and tests: give antibiotic, immunosuppressants, cultures, T-tube in dependent position

thyroidectomy complications: hemorrhage

- Monitor dressing, change if needed, report bleeding

for suspected GI bleed: expected orders

- NGT on Low-intermittent suction - IVFs - initiate continuous ECG - test stools for occult blood

nursing role in hepatic encephalopathy

- Neuro assessments, - I/O, - VS, - Nutritional support - Monitor labs (hypokalemia r/t lactulose)

enteral feeding complications

- Overfeeding (greater quantity of feeding than can be digested) - diarrhea (secondary to concentration of feeding) - aspiration pneumonia (due to aspiration of feeding) - refeeding / dumping syndrome (occurs when feeding started in client in severe starvation state)

thyroidectomy complications: thyroid storm

- Overwhelming thyroid hormones. High mortality. - Symptoms: Hyperthermia, hypertension, ECG/mental changes - treatment: ABCs, Tylenol, cooling, fluids

Protecting caregivers from chemo

- PPE - education about handling and disposing of chemotherapy agents and supplies - management of accidental spills or exposures - emergency spill kits - precautions when handling body fluids or excretions from patient - linens contaminated w chemo or blood or body fluids should be placed in hazardous containers (yellow containers) - PPE should be placed in it too - wash hands with soap and water after removing gloves used to prepare or administer chemo or clean contaminated linens and other materials - infuse patients to flush toilet with lid shut twice after using bathroom to prevent exposing others to the chemo excretions - certain chemotherapy can be excreted during sex as well so educate patients receiving these chemos

long-term complications of chemotherapy

- abnormalities in taste, smell, touch - abnormal balance, tremors, weakness - avascular necrosis - cardiovascular toxicity (CAD, MI, CHF, valvular heart disease, PAD) - decreased libido - dental caries - xerostomia - dysphagia - dyspnea on exertion - growth retardation in kids - herpes infections (zoster and varicella) - hypothyroidism - immune dysfunction - infertility - osteoporosis - pericarditis - pneumococcal sepsis - pneumonitis - secondary cancers (acute myeloid leukemia, myelodysplastic syndromes, non-hodgkin lymphoma, solid tumors like bone and soft tissue/lung/breast, thyroid cancer, thymic hyperplasia)

management issues specific to oncologic disorders

- assess pt's understanding of genetic factors r/t cancer - offer appropriate genetics information and resources - refer for cancer risk assessment when a hereditary cancer syndrome is suspected so the patient and family can discuss inheritance risk with other family members and availablity of genetic testing - provide support to patients and families with known genetic test results for hereditary cancer syndromes. refer to support groups. - participate in management and coordination of risk reduction measures for those with known gene mutations.

long term venous access devices

- continuous infusion of vesicants that takes LONGER THAN 1 HOUR or are given FREQUENTLY are given only via a central line (PICC, Iport, right atrial silastic catheter) - promote safety during med administration and reduce problems with repeated access to the circulatory system - require consistent nursing care

treatment for hepatitis

- for types A and B, prevention is key with immunizations - mostly supportive care - antivirals (tenofovir, adefovir, interferon alfa - 2b) for hep B, - combo peginterferon alfa 2a/ribovirun for hep C

specifics for enteric NGTs

- get X-ray to make sure it passes midline and passed the pylorus - continuous feeds only, no bolus - still check residuals - good for patients that are intubated and already an aspiration risk

Chemotherapy hypersensitivity

- high risk - associated with life-threatening outcomes - unexpected and associated with mild or progressively worsening signs and symptoms - s/sx: rash, urticaria, fever, hypotension, cardiac instability, dyspnea, wheezing, throat tightness, syncope - immediate hypersensitivity rxns happen within 5 minutes and up to 6 hours after infusion - delayed HSRs occur after completion of infusion - repeated exposure of chemo agent increases likelihood of HSR

family history assessment specific to oncologic disorders

- info about both mom and dad's side of family for 3 generations - obtain cancer history for at least 3 generations - look for clustering of cancers that occur at young ages, multiple primary cancers in one individual, cancer in paired organs, and two or more close relatives with the same type of cancer suggestive of hereditary cancer syndromes

what medications are included in the quadruple therapy for H. pylori? (SATA) metronidazole bismuth subcitrate / bismuth subsalicylate amoxicillin tetracycline clarithromycin PPI rocephin

- metronidazole - bismuth subcitrate / bismuth subsalicylate - tetracylcine - PPI

Expected provider orders for DKA

- obtain capillary blood glucose every 1 hour. - obtain blood and urinalysis for ketones. - obtain ABGs - repeat potassium level every 2 hours.

Primary Aldosteronism (Conn's Syndrome)

- patient exhibits profound alkalosis and hypokalemia - Hypertension is the most prominent and almost a universal sign of aldosteronism - Hypokalemic alkalosis may decrease serum calcium level resulting in tetany and paresthesia - Glucose intolerance may occur leading to hyperglycemia - The urine volume is excessive, leading to polyuria - Serum by contrast becomes concentrated leading to polydipsia

reconstructive surgery in cancer

- performed to restore function and normal appearance, and correct deformities - ex) breast implants after a mastectomy due to breast cancer

Addison's disease treatment

- prevent circulatory shock, fluid/electrolyte imbalances - give IVF and IV hydrocortisone, - treat hyperkalemia and hypoglycemia - No stimulants Monitor for: GI bleeding hypoglycemia. Report: adrenal insufficiency. increase steroid dose with stress or illness replace Na if n/v - High protein, high carb diet - Weigh daily - Injectable IV hydrocortisone or other steroids

addisonian crisis complications: hyponatremia treatment

- replace electrolytes (specifically sodium) with IVF - supplement diet with sodium to compensate for GI losses (N/V/D)

prevention of extravasation

- selection of peripheral veins - skilled venipuncture - careful administration of meds - short duration infusion (less than 1 hour) - continuous infusion of vesicants that takes LONGER THAN 1 HOUR or are given FREQUENTLY are given only via a central line (PICC, Iport, right atrial silastic catheter)

what can be the cause circulatory collapse in a patient with addison's disease

- slight overexertion - exposure to cold - acute infection - decrease in salt intake - stress before a surgery - dehydration from prepping for diagnostic tests

addison's disease complications: addisonian crisis

- sudden acute adrenal insufficiency - rapid onset, medical emergency - due to infection/trauma or abrupt discontinuation of steroids

contributing factors to homelessness

- unemployment - mental illness - relationship problems - substance abuse - availability of housing - illness - pets - disasters - sex trafficking - runaways

pre-liver transplant

- witness consent - multidisciplinary involvement

enteric tubes

-Dobhoff (duodenal or jujenal), Enteraflo; weighted tip for special placement - gastric -*ONLY* used for feedings; *cannot* give meds or suction

radiation dosage

-Dosage is dependent on the sensitivity of the target tissues to radiation and on the tumor size, radiation tolerance of surrounding normal tissues, and critical structures adjacent to tumor target -Lethal tumor dose is defined as the dose that will eradicate 95% of the tumor yet preserve normal tissue -With external radiation, the total radiation dose is delivered over several weeks to allow healthy tissue to repair and to achieve greater cell kill by exposing more cells to the radiation as they begin active cell division

secondary prevention for cancer

-Early detection -Screening -Identify high risk patients - Educate patietns about self-breast exam, self-testicular exam, pap-smear, colonoscopy -Education: cancer screening -Specific screenings for: *Skin cancer *Cervical cancer (papsmears) *Breast cancer (45) *Prostate cancer (70) *Colorectal cancer (50, if family history, earlier)

advantages of enteral feedings

-Safe and cost-effective -Preserve GI integrity -Preserve the normal sequence of intestinal and hepatic metabolism -Maintain fat metabolism and lipoprotein synthesis -Maintain normal insulin and glucagon ratios

GERD is associated with

-Tobacco use -Coffee drinking -Alcohol consumption -Gastric infection with Helicobacter pylori -meds that relax the lower esophagus like theophylline, nitrates, calcium channel blockers, anticholinergics, diazepam

Palliative surgery for cancer

-Used for symptom relief to increase comfort and improve quality of life -Not used to increase life expectancy

Protecting Caregivers from Radiation

-dosimeter to measure exposure to radiation -patient may require reverse isolation -keep distance from patient if possible -educate patient and family members for brachytherapy: - assigning patient to a private room - having staff members wear dosimeters - making sure that pregnant staff members are not assigned to patient's care - prohibiting visits by children or pregnant visitors - limiting visits from others to 30 minutes/day - seeing that visitors remain 6 feet away from radiation source

patient education with addison's disease

-medical alert bracelet -daily oral steroids -stress management (avoid emotional stress) - avoid cold exposure - avoid infections -emergency kit with 100 mg IM hydrocortisone -pt identifies under or over dosage symptoms -when to give oral steroid vs injection - increase steroid dose with stress or illness - do not take any stimulants - monitor for GI bleeding - monitor for hypoglycemia - its important to replace sodium if you are vomiting - watch for cushings syndrome symptoms - take steroids with food - do not DC steroids abruptly

Quadruple therapy for H. pylori

-tetracycline -metronidazole *both broad spectrum antibiotics -PPI -bismuth (for coating and eradication)

what meds decrease the effects of levothyroxine

1. antacids decrease the effects of levothyroxine 2. calcium decreases the effects of levothyroxine 3. iron decreases the effects of levothyroxine 4. fiber decreases the effects of levothyroxine

Zenker diverticulum presentation

1. feeling that something is stuck in the back of the throat 2. dysphagia 3. obstruction 4. halitosis (stank breath) - rotting food that is stuck in the diverticulum

what meds are effected by levothyroxine and how?

1. increases the effects of warfarin 2. decreases the effects of digoxin and insulin, so you have to up the dosage for digoxin and insulin

After receiving change-of-shift report, which of these patients should the nurse assess first?

24-year-old who is receiving neck radiation and has blood oozing from the neck

symptoms of hyperglycemia hyperosmolar syndrome

3 Ps (polydipsia, polyphagia, polyuria) blurred vision, dehydration, seizures, reversible paralysis, coma

symptoms of DKA

3 Ps, (polyuria, polyphagia, polydipsia) blurred vision, dehydration, GI ailments, fruity breath, kussmauls respirations, metabolic acidosis

carcinogenesis

3 steps: 1. initiation: apoptosis (cellular death fails) 2. promotion: preneoplastic / benign lesions 3. progression: angiogenesis

medications for ulcerative colitis and crohn's disease

5-aminosalicylic acid (anti-inflammatory) Sulfonamides Nonsulfamides Immunosuppressants Immunomodulators Antidiarrheals

non viral hepatitis: drug induced

50% all liver failure cases Tylenol most common cause

Which of the following is commonly a warning sign for cancer? Halitosis Lacrimation A Sore That Does Not Heal Daytime Drowsiness Hyperirritability Angiokeratoma

A Sore That Does Not Heal Guy with Sores That Will Not Heal A sore that does not heal in a reasonable timeframe may indicate cancer. If located on the skin or mouth, assess for skin or oral cancer.

A nurse is caring for a client who has lung cancer and is scheduled for a lobectomy. The nurse should prepare the client to expect which of the following after the procedure?

A chest tube

A nurse is caring for a client who has lung cancer and is scheduled for a lobectomy. The nurse should prepare the client to expect which of the following after the procedure?

A chest tube Answer Rationale: A lobectomy is major surgery that involves a large posterolateral or anterolateral incision into bone, muscle, and cartilage. Chest tubes are placed to drain air and fluid and remain in place for several days postoperatively.

The medical-surgical nurse has worked with numerous clients who have had difficult and stressful courses of treatment. What client likely faces the greatest risk for developing post-traumatic stress disorder? A client with a recent diagnosis of type 1 diabetes who is just learning to use an insulin pump A child who has endured repeated treatments for cancer over multiple admissions A client who required a skin graft as a result of an infected surgical incision A client whose chronic kidney disease requires hemodialysis three times per week

A child who has endured repeated treatments for cancer over multiple admissions Explanation: Medical problems and hospitalizations are known to be intensely stressful. However, the risk of PTSD is particularly high among cancer survivors, especially those with multiple admissions and prolonged treatment. In a landmark study, childhood cancer survivors have been found to have four times the risk of developing PTSD as their siblings.

A charge nurse is planning to admit several clients to the medical unit. Which of the following clients should the nurse assign to a private room?

A client who is neutropenic Answer Rationale: Clients who have neutropenia (a low count of neutrophils, a type of WBC that helps fight infection) due to immune system compromise, such as clients who have leukemia or major burns or are receiving chemotherapy or allogenic hematopoietic stem cell transplants, require a protective environment to prevent the spread of pathogens to the clients requiring the protective environment. This means a private room with positive airflow.

definition and purpose of parenteral nutrition

A complex mixture containing proteins, carbohydrates, fats, electrolytes, vitamins, trace minerals, and sterile water is administered in a single container May be delivered peripherally or via a central line, depending on the solution's hypertonicity Ability/desire to ingest food orally or by tube is impaired The underlying medical condition precludes oral or tube feeding Preoperative and postoperative nutritional needs are prolonged

a nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. the nurse should identify which of the following findings as an indication that the medication is effectiive? A decrease in blood sugar A decrease in blood pressure A decrease in urine output A decrease in specific gravity

A decrease in urine output The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.

Tumor removal surgery

A form of cancer therapy that involves solid tumor removal with little surrounding cell damage. It is also used to de-bulk larger tumors and as a diagnostic tool. It is commonly used in tandem with focal radiation to remove remaining cells after surgery.

cancer definition

A group of disorders characterized by abnormal cell proliferation, in which cells ignore growth-regulating signals in the surrounding environment Disease process that begins when a cell is transformed by genetic mutation of cellular DNA

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis?

A liver biopsy Explanation: A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle. A prothrombin time and platelet count will assist with determining if the client is at increased risk for bleeding.

Which individual is most likely to be diagnosed with posttraumatic stress disorder (PTSD)? An adult male client who has been admitted to the hospital three times for complications of surgery A middle-aged woman with a history of anxiety who suffered a random physical assault A 12-year-old girl who has recently moved cross-country and desperately misses her old friends A teenage boy who has begun to be the object of bullying inside and outside the classroom

A middle-aged woman with a history of anxiety who suffered a random physical assault Explanation: Woman are twice as likely as men to develop PTSD, and a history of anxiety is a known risk factor. Physical assault is among the most common precursors to PTSD. Each of the other listed individuals is facing a crisis that has the potential to result in trauma, but none has the same constellation of risk factors as the middle-aged woman.

a nurse is teaching a client about the seven warning signs of cancer. which of the following signs should the nurse include as a manifestation of cancer? sata A nonhealing sore Bloating Change in bowel pattern Change in moles Nagging cough

A nonhealing sore Change in bowel pattern Change in moles Nagging cough A nonhealing sore is correct. A client who has cancer might exhibit a nonhealing sore. Bloating is incorrect. Bloating is not one of the seven warning signs of cancer. Change in bowel pattern is correct. A client who has cancer might exhibit a change in bowel pattern. Change in moles is correct. A client who has cancer might exhibit a change in the appearance of warts or moles. Nagging cough is correct. A client who has cancer might exhibit a nagging cough.

A nurse is teaching a patient about the seven warning signs of cancer. Which of the following signs should the nurse include as manifestations of cancer? Select all that apply.

A nonhealing sore Change in bowel pattern Change in moles Nagging cough

An psychosocial assessment of a homeless client is different from a physical assessment. Which best describes the difference? A psychosocial assessment is a head-to-toe assessment by a provider. A physical assessment focuses on the client's observed behaviors and how the provider interprets the interaction. A psychosocial assessment is conducted by the provider using observation and listening to the client. A physical assessment uses questions to assess, and documentation focuses on the client's responses.

A psychosocial assessment is conducted by the provider using observation and listening to the client. Explanation: The psychosocial assessment is a behavioral assessment to gain insight into a client's life and mental health issues. Much of the assessment is conducted through observation and listening to the client's explanation of events. The physical assessment is a head to toe assessment by the provider.

dissociative identity disorder (DID)

A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Also called multiple personality disorder.

types of hepatitis

A, B, C, D, E

A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patient's fluid volume excess? Select all that apply. A. Administering diuretics B. Administering calcium channel blockers C. Implementing fluid restrictions D. Implementing a 1500 kcal/day restriction E. Enhancing patient positioning

A. Administering diuretics B. Administering calcium channel blockers E. Enhancing patient positioning Rationale: Administering diuretics, implementing fluid restrictions, and enhancing patient positioning can optimize the management of fluid volume excess. Calcium channel blockers and calorie restriction do not address this problem.

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

A. Alanine aminotransferase (ALT) B. C-reactive protein (CRP) D. Aspartate aminotransferase (AST) Rationale: Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.

malignant process

Cell proliferation: -Genetically altered cells clone and proliferate abnormally -Evading normal intra/extracellular processes such as growth regulating and immune system defenses -Abnormalities in cell signaling processes lead to cancer development -Ultimately metastasis occurs

A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease? A. Asterixis B. Constructional apraxia C. Fector hepaticus D. Palmar erythema

A. Asterixis Rationale: The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple figure. Fector hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but is not a flapping tremor.

A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment? A. Destruction of the patient's liver tumor B. Restoration of portal vein patency C. Destruction of a liver abscess D. Reversal of metastasis

A. Destruction of the patient's liver tumor Rationale: Using radiofrequency ablation, a tumor up to 5 cm in size can be destroyed in one treatment session. This technique does not address circulatory function or abscess formation. It does not allow for the reversal of metastasis.

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace? A. Disposing of sharps appropriately and not recapping needles B. Performing meticulous hand hygiene at the appropriate moments in care C. Adhering to the recommended schedule of immunizations D. Wearing an N95 mask when providing care for patients on airborne precautions

A. Disposing of sharps appropriately and not recapping needles Rationale: HCV is blood-borne. Consequently, prevention of needle stick injuries are paramount. Hand hygiene, immunizations and appropriate use of masks are important aspects of overall infection control, but these actions do not directly mitigate the risk of HCV.

A nurse educate is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply. A. Immunizations B. Use of standard precautions C. Consumption of vitamin-rich diet D. Annual vitamin K injections E. Annual vitamin B12 injections

A. Immunizations B. Use of standard precautions Rationale: People who are at high risk, including nurses and other health care personnel exposed to blood or blood products, should receive active immunization. The consistent use of standard precautions is also highly beneficial. Vitamin supplementation is unrelated to an individual's risk of HBV.

A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse's best response to this assessment finding? A. Document the presence of normal bile output. B. Irrigate the drainage system with normal saline as ordered. C. Aspirate a sample of the drainage for culture. D. Promptly report this assessment finding to the primary care provider.

A. Document the presence of normal bile output. Rationale: Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary.

During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus? A. Following proper hand-washing techniques B. Avoiding chemicals that are toxic to the liver C. Wearing a condom during sexual contact D. Limiting alcohol intake

A. Following proper hand-washing techniques Rationale: Avoiding contact with the hepatitis E virus through good hygiene, including hand-washing, is the major method of prevention. Hepatitis E is transmitted by the fecaloral route, principally through contaminated water in areas with poor sanitation. Consequently, none of the other listed preventative measure is indicated.

A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patient's presentation? A. How many alcoholic drinks do you typically consume in a week? B. To the best of your knowledge, are your immunizations up to date? C. Have you ever worked in an occupation where you might have been exposed to toxins? D. Has anyone in your family ever experienced symptoms similar to yours?

A. How many alcoholic drinks do you typically consume in a week? Rationale: Signs or symptoms of hepatic dysfunction indicate a need to assess for alcohol use. Immunization status, occupational risks, and family history are also relevant considerations, but alcohol use is a more common etiologic factor in liver disease.

malignant cells -- characteristics

Cells are undifferentiated and may bear little resemblance to the normal cells of the tissue from which they arose.

A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurse's priority? A. Implementation of infection-control measures B. Close monitoring of skin integrity and color C. Frequent assessment of the patient's psychosocial status D. Administration of antiretroviral medications

A. Implementation of infection-control measures Rationale: Infection control is paramount following liver transplantation. This is a priority over skin integrity and psychosocial status, even though these are valid areas of assessment and intervention. Antiretrovirals are not indicated.

A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure? A. Position the patient on the right side with a pillow under the costal margin after the procedure B. Administer 1 unit of albumin 90 minutes before the procedure as ordered C. Administer at least 1 unit of packed red blood cells as ordered the day before the scheduled procedure D. Confirm that the patient's electrolyte levels have been assessed prior to the procedure

A. Position the patient on the right side with a pillow under the costal margin after the procedure. Rationale: Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin. Prior administration of albumin or PRBC's is unnecessary. Coagulation tests should be performed, but electrolyte analysis is not necessary.

A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning the patient's continuing care, the nurse should prioritize which of the following risk diagnoses? A. Risk for infection related to immunosuppressant use B. Risk for injury related to decreased hemostasis C. Risk for unstable blood glucose related to impaired gluconeogensis D. Risk for contamination related to accumulation of ammonia

A. Risk for infection related to immunosuppressant use Rationale: Infection is the leading cause of death after liver transplantation. Pulmonary and fungal infections are common; susceptibility to infection is increased by the immunosuppressive therapy that is needed to prevent rejection. This risk exceeds the threats of injury and unstable blood glucose. The diagnosis of risk for contamination related to environmental toxin exposure.

A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patient's current medication regimen includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? A. Two to 3 soft bowel movements daily B. Significant increase in appetite and food intake C. Absence of nausea and vomiting D. Absence of blood or mucus in stool

A. Two to 3 soft bowel movements daily Rationale: Lactulose (Cephulac) is administered to reduce serum ammonia levels. Two or three soft stools per day are desirable; this indicates that lactulose is performing as intended. Lactulose does not address the patient's appetite, symptoms of nausea and vomiting, or the development of blood and mucus in the stool.

Myxedema nursing interventions / considerations

ABCs, monitor neuro status (can slip into coma), keep warm, IVF, levothyroxine bolus, treat / replenish electrolytes

addisons memory trick

ADDison's Absent steroids LOW Small, weak, tanned low BP = ticking time bomb

A nurse is developing an educational program for veterans who have alcohol use disorder (AUD). Which information should the nurse include in the teaching session? AUD is associated with other mental health issues. Presence of comorbidities are equivalent across ethnicity and racial groups. AUD is more prevalent in the White veteran population. Depression is rarely seen in AUD as a comorbidity.

AUD is associated with other mental health issues. Explanation: AUD is correlated with other mental health issues such as PTSD, depression, and major depressive disorder. Presence of comorbidities varies across ethnicity and racial groups. AUD is more prevalent in Hispanic veterans and veteran populations of African descent.

A nurse is reviewing research statistics related to alcohol use disorder (AUD) in veterans. Which statement is accurate as it relates to current research findings? Veterans are just as likely as non-veterans to have AUD. AUD is considered to be more prevalent in veterans than other types of substance abuse. AUD is seen more in urban areas than rural communities in the veteran population. The veteran population with AUD exceeds more than 50%.

AUD is considered to be more prevalent in veterans than other types of substance abuse. Explanation: AUD is the most prevalent mental health disorder in the veteran population. Current research shows that the veteran population meets the lifetime criteria of AUD at 42.2%. Veterans are more likely to have AUD than their non-veteran counterparts. There is no reported research related to urban versus rural demographics for AUD.

compensated cirrhosis symptoms

Abd pain ankle edema enlarged liver mild fever reddened palms splenomegaly epistaxis vague morning indigestion vascular spiders

The nurse is caring for a client recovering from an esophagogastroduodenoscopy (EGD). Which of the following client symptoms would require further nursing assessment?

Abdominal distention Explanation: The nurse is correct to fully assess the client experiencing abdominal distention following an esophagogastroduodenoscopy (EGD). Abdominal distention could indicate complications such as perforation and bleeding. The client experiences drowsiness from the sedative during the early recovery process and a sore throat from passage of the scope. The client may also experience thirst because the client has not had liquids for a period of time.

metastasis

Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body

hypoparathyroidism

Abnormal development, destruction, vit D deficiency

Which of the following is the primary function of the small intestine?

Absorption Explanation: Absorption is the primary function of the small intestine. Digestion occurs in the stomach. Peristalsis occurs in the colon. The duodenum secretes enzymes.

A community-based clinic is offering education classes at a local shelter. The nurse performs a needs assessment on which topics might be most important for the clients at the shelter. After analyzing the data, the nurse would likely plan a session on which of the following topics? Accessing emergency services Eating a balanced diet Signs of developing diabetes How to file insurance claims

Accessing emergency services Explanation: Homeless clients need information to promote health and to use pertinent health care resources. Client education may include topics such as personal hygiene, recognizing and treating infestation, thermoregulatory disorders, tuberculosis screening, respiratory problems, sexually transmitted infections, signs of domestic violence, emergency services, and substance abuse issues. The nurse also educates clients about the nature of mental illness; symptoms to expect; side effects, risks, and benefits of prescribed medications; and ways to negotiate the complexities of the mental health system.

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:

Acetaminophen Explanation: Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Other medications commonly associated with liver injury include anesthetic agents, medications used to treat rheumatic and musculoskeletal disease, antidepressants, psychotropic medications, anticonvulsants, and antituberculosis agents.

The nurse is providing continuing care to a client who has experienced significant trauma. When assessing the client throughout the course of care, the nurse would be alert for signs and symptoms associated with condition related to the trauma? Select all that apply. Adjustment disorder Posttraumatic stress disorder Eating disorder Reactive attachment disorder Acute stress disorder

Acute stress disorder Posttraumatic stress disorder Adjustment disorder Reactive attachment disorder Explanation: Exposure to a traumatic or otherwise stressful event can lead to a trauma- and stressor-related disorder such as reactive attachment disorder, disinhibited social engagement disorder, PTSD, acute stress disorder, and adjustment disorder. Eating disorder is not typically associated with trauma.

addison's disease complications (5)

Addisonian crisis, hypoglycemia, hyperkalemia, hyponatremia leukocytosis

A nurse is working with a military client to obtain a health history. Which nursing action best represents awareness of the military culture? Address the client by rank when asking questions. Tell the client to sit down while questions are being asked. Clarify the stated health concern of the client. Ask the client to remain standing during the health history.

Address the client by rank when asking questions. Explanation: Awareness of the military culture involves honor, pride, discipline and loyalty, warrior beliefs, and self-sacrifice. By addressing the client by rank the nurse shows deference to the military culture. Telling the client to sit down or stand up does not correlate with acknowledgment of the military culture. Clarifying the stated health concern of the client is necessary for the health history but it does not correlate with acknowledgment of the military culture.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? Adjuvant therapy is likely. Palliative care is likely. Repeat biopsy is needed before treatment begins. No further treatment is indicated.

Adjuvant therapy is likely. Explanation: T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.

A nurse is preparing a client who is to receive chemotherapy for treatment of ovarian cancer. Which of the following actions should the nurse plan to take?

Administer an antiemetic prior to the procedure. Answer Rationale: The nurse can help prevent nausea and vomiting by administering an antiemetic prior to chemotherapy, and to tell the client to continue taking medication until nausea and vomiting resolve.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? Encouraging rhythmic breathing exercises Withholding fluids for the first 4 to 6 hours after chemotherapy administration Administering metoclopramide and dexamethasone as ordered Serving small portions of bland food

Administering metoclopramide and dexamethasone as ordered Explanation: The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.

Addison's disease

Adrenocortical Insufficiency or dysfunction to adrenal cortex

a nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. the nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? Hyperglycemia Adrenocortical insufficiency Severe dehydration Rebound pulmonary congestion

Adrenocortical insufficiency Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.

A nurse is caring for a client who is in the immediate postoperative period following a partial laryngectomy. Which of the following parameters should the nurse assess first?

Airway patency When using the airway, breathing, circulation approach to client care, the nurse determines that the priority assessment is airway patency. After head and neck surgery, a major, life-threatening complication is airway obstruction. The priority actions involve airway maintenance and gas exchange

a nurse is caring for a client who has Cushing's Syndrome. the nurse should recognize that which of the following are a manifestation of Cushing's syndrome? (SATA) Alopecia Tremors Moon face Purple striations Buffalo hump

Alopecia Moon face Purple striations Buffalo hump Alopecia is correct. Clients who have Cushing's syndrome can develop hirsutism, which is excessive body hair. Women can also develop alopecia, in the form of male pattern baldness. Moon face is correct. Moon face, which is manifested by a round, red, full face, is a common manifestation of Cushing's syndrome. Purple striations is correct. Purple striations on the skin of the abdomen, thighs, and breasts are common manifestations of Cushing's syndrome. Buffalo hump is correct. Buffalo hump, which is a collection of fat between the shoulder blades, is a common manifestation of Cushing's syndrome.

Which is a sign or symptom of septic shock? Altered mental status Hypertension Warm, moist skin Increased urine output

Altered mental status Explanation: Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.

A nurse on an oncology unit is preparing to administer doxorubicin to a client who has breast cancer. Prior to beginning infusion, the nurse verifies the client's current cumulative lifetime dose of the medication. For which of the following reasons is this verification necessary?

An excess amount of doxorubicin can lead to cardiomyopathy

number 1 cause of aspiration pneumonia

NGT displacement

medications for peptic ulcer disease

Antibiotics: Metronidazole, amoxicillin eliminate H. Pylori H2 receptor antagonists: Ranitidine, famotidine Protein pump inhibitors: Pantoprazole, esomeprazole Antacids: Aluminum hydroxide Mucosal protectants: Bismuth salts

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? Antimetabolite Alkylating Mitotic spindle poisons Nitrosoureas

Antimetabolite Explanation: 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR).

After radiation treatment, a client reports dryness, redness, and scaling of his skin occurring within the designated radiation treatment markings. The nurse should instruct the client to take which of the following actions?

Apply hydrating lotions. Answer Rationale: The nurse should instruct the client to gently apply hydrating lotions that do not contain metal, alcohol, or perfume

A client on interferon therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the assistive personnel? Select all that apply.

Apply moisturizers to dry skin Bathe the client using mild soap

A nurse in the post-anesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give highest priority to?

Arterial blood gases Answer Rationale: According to the ABC priority-setting framework, the postoperative surgical client may need supplemental oxygen in order to maintain normal blood oxygen levels. The effectiveness of oxygenation is monitored using pulse oximetry and arterial blood gases

decompensated cirrhosis symptoms

Ascites clubbing gonadal atrophy hypotension jaundice muscle wasting purpura sparse body hair spontaneous bruising weakness weight loss

A nurse is assessing an active-duty military service client in the clinic. The client reports feelings of uneasiness when surrounded by superior officers even though there has been no physical contact. What is the best nursing response? Report the information because it is suggestive of military sexual trauma (MST). Refer the client for additional psychological screening. Refer the client for counseling. Ask for clarification of events.

Ask for clarification of events. Explanation: Although military sexual trauma (MST) should be reported, there is insufficient information for the nurse to make either medical/counseling referrals and/or initiate the process for follow-up evaluation of MST. Rather the nurse should attempt to obtain further information to clarify the nature of the comment.

The nurse is preparing the client for an assessment of the abdomen. What should the nurse complete prior to this assessment?

Ask the client to empty the bladder. Explanation: The physical examination of the gastrointestinal system includes assessment of the mouth, abdomen, and rectum. It requires good light, full exposure of the abdomen, warm hands with short nails, and a relaxed client with an empty bladder. A full bladder will interfere with inspection and may elicit discomfort with palpation and percussion, thereby altering results.

A veteran client reports to the nurse with feelings of detachment during daily activities of life and avoids eye contact during the interview. Which priority action should the nurse implement? Ask the client to expand on feelings. Use therapeutic touch to convey support. Tell the client to change their daily routine. Encourage the client to do daily exercise.

Ask the client to expand on feelings. Explanation: The client statement indicates the presence of numbing symptoms (flat affect and unable to participate fully either physically or emotionally in life). It would be important to ask the client to expand on feelings so as to get a better idea of the extent of the problem. Although the use of therapeutic touch may be needed eventually, to a client who reports detachment with avoidance of eye contact the use of touch may be viewed as confrontational. Modifications to one's routine and inclusion of daily exercise may eventually be needed, but the priority is to determine the etiology of the problem.

A client's family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? Select all that apply.

Ask the family to describe their concerns more fully Consult with a social worker, chaplain, or ethics committee Explain the client's right to know and ask for their assistance

A client receiving chemotherapy has a white blood cell count of 1000/mm^3. What actions by the nurse are most appropriate? Select all that apply.

Assess all mucous membranes every 4-8 hours Listen to lung sounds and monitor for cough Monitor venous access device appearance with vital signs Take and record vital signs every 4 to 8 hours

peptic ulcer: hemorrhage nursing actions

Assess for evidence of bleeding, hematemesis or melena, and symptoms of shock/impending shock and anemia Treatment includes IV fluids, NG, and saline or water lavage; oxygen, treatment of potential shock including monitoring of VS and UO; may require endoscopic coagulation or surgical intervention

The family members of a military veteran are distraught that he has withdrawn from them emotionally after returning home from a tour of duty. What is the nurse's most appropriate action? Educate the family about the usual emotional responses to returning home from military service Assess the client for signs and symptoms associated with post-traumatic stress disorder Organize a family meeting where family members can tell the client how they feel Educate the family about the relationship between hyperarousal and emotional distance

Assess the client for signs and symptoms associated with post-traumatic stress disorder Explanation: It is highly plausible that the client has post-traumatic stress disorder, given the high incidence and prevalence among veterans. Assessment should precede any interventions such as family meetings or education sessions.

An oncology client has just returned from the postanesthesia care unit after an open hemicolectomy. This client's plan of nursing care should prioritize which of the following? Assess the client's fine motor skills once per shift. Assess the client's wound for dehiscence every 4 hours. Maintain the client's head of bed at 45 degrees or more at all times. Assess the client hourly for signs of compartment syndrome.

Assess the client's wound for dehiscence every 4 hours. Explanation: Postoperatively, the nurse assesses the client's responses to the surgery and monitors the client for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. Fine motor skills are unlikely to be affected by surgery and compartment syndrome is a complication of fracture casting, not abdominal surgery. There is no need to maintain a high head of bed.

nursing management in chemo

Assessing fluid, electrolyte status - anorexia, n/v, altered taste, mucositis, diarrhea. - ongoing assessment and identify ways to encourage adequate fluid and dietary intake - assess pt's normal practices for oral hygiene - assess oral cavity daily for evidence of stomatitis and ulcers - assess for dehydration, infection, pain, and nutritional impairment - maintain good oral hygiene - brushing, flossing, rinsing, dental care - palifermin (IV synthetic human keratinocyte) can prevent and manage stomatitis (promotes epithelial cell repair and replacement of cells in mouth and GI tract) - cryotherapy (oral ice during infusions) - low-level laser therapy - sodium bicarb mouth rinse Assessing cognitive status - assess for signs of impairment - inform family about possibility of cognitive changes PRIOR to treatment - remembering dates, multitasking, managing numbers and finances, organization, face / object recognition, inability to follow directions, easily distracted, motor and behavioral changes) - reccommend: exercise, walking in nature / gardening, cognitive training programs Modifying risks for infection, bleeding - decreasing the risk of infection and bleeding Administering chemotherapy - emphasize to pt and family the importance of adhering to prescribed self-administered premedication before coming to infusion center, and recognizing and reporting signs and symptoms to the nurse once the infusion has started. - pt and family also educated about symptoms that may occur at home following discharge from the infusion area that may warrant med administration or IMMEDIATE transport to the ED for further assessment and treatment Preventing nausea and vomiting - select effective antiemetic regimens - educate pt and family about delayed chemo-induced-nausea-and-vomiting that may occur at home after the infusion is completed Managing fatigue - assist pt in exploring the role that the disease processes, combined treatments, other symptoms, and psychosocial distress play in the patient's experience of fatigue - identify effective approaches for fatigue management Protecting caregivers - be familiar with policies and procedures regarding PPE, handling and disposal of chemo and supplies, management of accidental spills or exposure - emergency spill kits should be available in any treatment area where chemo is given or prepared - precautions when handling body fluids - educate family about precautions

The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment? Assessing the client's vital signs Assessing the quantity and quality of the client's sleep Assessing the client's communication skills Assessing the quality of the client's support network

Assessing the quantity and quality of the client's sleep Explanation: Intrusion almost always takes a toll on the client's sleep. Communication and social support are only peripherally related to episodes of intrusion. Intrusion will certainly affect the client's vital signs, but these changes are unlikely to be as problematic as sleep difficulties.

A client has mucositis. What actions by the nurse will improve the client's nutrition? Select all that apply.

Assist with rinsing the mouth with saline frequently Encourage the client to eat room-temperature foods Provide local anesthetic medications to swish and spit Remind the client to brush teeth gently after each meal

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?

Asterixis Explanation: Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy

nursing care for peptic ulcer disease

Avoid foods that cause distress (coffee/tea, carbonation) Monitor for gastrointestinal bleeding or perforation. Administer saline lavage via nasogastric tube. Administer medication as prescribed. Decrease environmental stress. Encourage rest periods, smoking cessation and avoiding alcohol consumption. Monitor laboratory results Relieve pain/anxiety

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? Eat wholesome meals. Eat warm or hot foods. Avoid spicy and fatty foods. Avoid intake of fluids.

Avoid spicy and fatty foods. Explanation: The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.

A nurse working in an emergency shelter for the homeless tells a new colleague that there has been a change in the focus for homeless people in regards to housing. What is this shift? Away from creating emergency shelters to developing more permanent housing Away from having high rents to lower rents Away from having waiting lists for public housing Away from using soup kitchens to instead having food voucher programs

Away from creating emergency shelters to developing more permanent housing Explanation: The focus of attempts to address the problem of homelessness have shifted away from creating emergency shelters to developing more permanent housing. At the same time, housing assistance programs have become limited, rents have increased, and waiting lists for public housing have become longer.

A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patient's care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence. 1. Fever rises 2. Hematemesis 3. Clotting abnormalities 4. Vascular collapse 5. Coma A. 1,2,5,4,3 B. 1,2,3,4,5 C. 2,3,1,4,5 D. 3,1,2,5,4

B. 1,2,3,4,5 Rationale: Recovery from acute toxic hepatitis is rapid if the hepatotoxin is identified early and removed or if exposure to the agent has been limited. Recovery is unlikely if there is a prolonged period between exposure and onset of symptoms. There are no effective antidotes. The fever rises; the patient becomes toxic and prostrated. Vomiting may be persistent, with the emesis containing blood. Clotting abnormalities may be severe, and hemorrhages may appear under the skin. The severe GI symptoms may lead to vascular collapse. Delirium, coma, and seizures develop, and within a few days the patient may die of fulminant hepatic failure unless he or she receives a liver transplant.

A patient with a history of injection drug use has been diagnosed with Hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention? A. Administration of immune globulins B. A regimen of antiviral medications C. Rest and watchful waiting D. Administration of fresh-frozen plasma (FFP)

B. A regimen of antiviral medications Rationale: There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that a combination of two antiviral agents, Peg-interferon and ribavirin (Rebetol), is effective in producing improvement in patients with hepatitis C and in treating relapses. Immune globulins and FFP are not indicated.

A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases? A. Persistent fever and cognitive changes B. Abdominal pain and hepatomegaly C. Peripheral edema unresponsive to diuresis D. Spontaneous bleeding and jaundice

B. Abdominal pain and hepatomegaly Rationale: The early manifestations of malignancy of the liver include pain, a continuous dull ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia, and anemia may also occur. The liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever, cognitive changes, peripheral edema, and bleeding are atypical signs.

A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis? A. Finish all prescribed courses of antibiotics, regardless of symptoms resolution. B. Adhere to dosing recommendations of OTC analgesics. C. Ensure that expired medications are disposed of safely. D. Ensure that pharmacists regularly review drug regimens for potential interactions.

B. Adhere to dosing recommendations of OTC analgesics. Rationale: Although any medication can affect liver function, use of acetaminophen (found in many OTC medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Finishing prescribed antibiotics and avoiding expired medications are unrelated to this disease. Drug interactions are rarely the cause of drug-induced hepatitis.

A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patient's plan of care? A. Measurement of abdominal girth and body weight B. Assessment for variceal bleeding C. Assessment for signs and symptoms of jaundice D. Monitoring of results of liver function testing

B. Assessment of variceal bleeding Rationale: Esophageal varices are a major cause of mortality in patients with uncompensated cirrhosis. Consequently, this should be a focus of the nurse's assessments and should be prioritized over the other listed assessments, even though each should be performed.

A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patient's prioritization for receiving a donor liver be determined? A. By considering that patient's age and prognosis B. By objectively determining the patient's medical need C. By objectively assessing the patient's willingness to adhere to post-transplantation care D. By systematically ruling out alternative treatment options

B. By objectively determining the patient's medical need Rationale: The patient would undergo a classification of the degree of medical need through an objective determination known as the Model of End-Stage Liver Disease (MELD) classification, which stratifies the level of illness of those awaiting a liver transplant. This algorithm considers multiple variables, not solely age, prognosis, potential for adherence and the rejection of alternative options.

nursing to monitor for SIADH

NS for all things, monitor HTN, fluid overload, report AMS

A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform? A. Keep patient NPO until the results of test are known B. Keep patient NPO until the patient's gag reflex returns C. Administer analgesia until post-procedure tenderness is relieved D. Give the patient a cold beverage to promote swallowing ability

B. Keep patient NPO until the patient's gag reflex returns Rationale: After the examination, fluids are not given until the patient's gag reflex returns. Lozenges and gargles may be used to relieve throat discomfort if the patient's physical condition and mental status permit. The result of the test is known immediately. Food and fluids are contraindicated until the gag reflex returns.

A nurse is caring for a patient with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate? A. Watery, blood-streaked diarrhea B. Orange and foamy urine C. Increased abdominal girth D. Decreased cognition

B. Orange and foamy urine Rationale: If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy. Bloody diarrhea, ascites, and cognitive changes are not associated with obstructive jaundice.

A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the patient's cognition and behavior. What is the nurse's most appropriate response? A. Ensure that the patient's sodium intake does not exceed recommended levels B. Report this finding to the primary care provider due to the possibility of hepatic encephalopathy C. Inform the primary care provider that the patient should be assessed for alcoholic hepatitis. D. Implement interventions aimed at ensuring a calm and therapeutic care environment.

B. Report this finding to the primary care provider due to the possibility of hepatic encephalopathy Rationale: Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. This change in status is likely unrelated to sodium intake and would not signal the onset of hepatitis. A supportive care environment is beneficial, but does not address the patient's physiologic deterioration.

Stage 3 Hepatic Encephalopathy

Stuporous; difficult to rouse; confused, incoherent speech; asterixis; Increased DTR; rigid extremities; EEG abnormal

Which of the following is the most definitive means of assessing for liver disease?

Biopsy Explanation: Liver biopsy is the most effective means of diagnosing liver disease. Guided liver biopsy can be conducted using laparoscopy, the insertion of a fiberoptic endoscope through a small abdominal incision. Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions. Cholecystography and ultrasonography may be used to detect gallstones. Ultrasonography may also be used to visualize the liver and diagnose conditions such as liver fibrosis; noninvasive techniques such as this can reduce the need for liver biopsy.

The nurse is to obtain a stool specimen from a client who reported that he is taking iron supplements. The nurse would expect the stool to be which color?

Black Explanation: Ingestion of iron can cause the stool to turn black. Meat protein causes stool to appear dark brown. Ingestion of large amounts of spinach may turn stool green while ingestion of carrots and beets may cause stool to turn red.

a nurse is admitting a child who has leukemia and a critically low platelet count. which of the following precautions should the nurse initiate? Neutropenic Bleeding Contact Droplet

Bleeding The nurse should initiate bleeding precautions for a child who has a low platelet count. Bleeding precautions involve specific measures to reduce the risk of bleeding, such as using soft-bristled toothbrushes, avoiding IM injections, and preventing constipation.

A nurse is caring for a client who has myelosuppression after receiving chemotherapy. The nurse should monitor the client for which of the following adverse effect?

Bleeding from the gums

A nurse is caring for a client who has myelosuppression after receiving chemotherapy. The nurse should monitor the client for which of the following adverse effects?

Bleeding from the gums Answer Rationale: Bleeding from the gums is directly related to myelosuppression due to inhibited bone marrow production of blood cells and platelets.

thyroidectomy complications: airway obstruction

Bleeding/tracheal collapse/edema interventions: - Trach kit at bedside, - high fowlers

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? Blood studies Family history Allergy history Drug history

Blood studies Explanation: Before the BMT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate the client's family, drug, or allergy history.

A nurse is preparing a teaching plan for a client who has neutropenia as a result of radiation therapy for the treatment of lung cancer. Which of the following should the nurse plan to include in the teaching?

Bottled water is an appropriate choice to increase fluid intake

During a colonoscopy with moderate sedation, the patient groans with obvious discomfort and begins bleeding from the rectum. The patient is diaphoretic and has an increase in abdominal girth from distention. What complication of this procedure is the nurse aware may be occurring?

Bowel perforation Explanation: Immediately after the test, the patient is monitored for signs and symptoms of bowel perforation (e.g., rectal bleeding, abdominal pain or distention, fever, focal peritoneal signs).

Cushing's disease symptoms

Buffalo hump Hyperglycemia Hypertension tachycardia Moon face Purple straie Thin-fragile skin truncal obesity GI ulcers Weight gain excessive facial hair, balding acne, easily bruised skin, slow healing cuts, irregular menstruation, decreased libido, bone fractures skin darkening

A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem? A) Assessment of blood pressure and assessment for headaches and visual changes B) Assessments for signs and symptoms of venous thromboembolism C) Daily weights and abdominal girth measurement D) Blood glucose monitoring q4h

C) Daily weights and abdominal girth measurement Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not create a risk for unstable blood glucose or VTE.

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

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

A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this patient is what? A. IV administration of immune globulins B. Transfusion of packed red blood cells and fresh-frozen plasma (FFP) C. Liver transplantation D. Lobectomy

C. Liver transplantation Rationale: Liver transplantation carries the highest potential for the resolution of fulminant hepatic failure. This is preferred over other interventions, such as pharmacologic treatments, transfusions, and surgery

A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem? A. Assessment of blood pressure and assessment for headaches and visual changes. B. Assessments for signs and symptoms of venous thromboembolism. C. Daily weights and abdominal girth measurement. D. Blood glucose monitoring q4h.

C. Daily weights and abdominal girth measurement Rationale: Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not create a risk for unstable blood glucose of VTE.

A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patient's treatment? A. Decisional Conflict B. Deficient Knowledge C. Death Anxiety D. Disturbed Thought Processes

C. Death Anxiety Rationale: The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse must address the patient's likely fear of death, which is a realistic possibility. For most patients, anxiety is likely to be a more acute concern than lack of knowledge or decisional conflict. The patient may or may not experience disturbances in thought processes.

A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient stated that she fell when transferring to the commode. The patient's vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse's most appropriate action? A. Remove the patient's commode and supply a bedpan B. Complete an incident report and submit it to the unit supervisor C. Have the patient assessed by the physician due to the risk of internal bleeding D. Perform a focused abdominal assessment in order to rule out injury.

C. Have the patient assessed by the physician due to the risk of internal bleeding Rationale: A fall would necessitate thorough medical assessment due to the patient's risk of bleeding. The nurse's abdominal assessment is an appropriate action, but is not wholly sufficient to rule out internal injury. Medical assessment is a priority over removing the commode or filling out an incident report, even though these actions are appropriate.

Diagnostic testing has revealed that a patient's hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patient's plan of care will focus on what intervention? A. Cryosurgery B. Liver transplantation C. Lobectomy D. Laser hyperthermia

C. Lobectomy Rationale: Surgical resection is the treatment of choice when HCC is confined to one lobe of the liver and the function of the remaining liver is considered adequate for postoperative recovery. Removal of a lobe of the liver (lobectomy) is the most common surgical procedure for excising a liver tumor. While cryosurgery and liver transplantation are other surgical options for management of liver cancer, these procedures are not performed at the same frequency as a lobectomy. Laser hyperthermia is a nonsurgical treatment for liver cancer.

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patient's liver? A. Place hand under the right lower abdominal quadrant and press down lightly with the other hand. B. Place the left hand over the abdomen and behind the left side at the 11th rib. C. Place hand under right lower rib cage and press down lightly with the other hand. D. Hold hand 90 degree to right side of the abdomen and push down firmly.

C. Place hand under right lower rib cage and press down lightly with the other hand. Rationale: To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal quadrant.

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

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

A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

C. Stage 3 Rationale: Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG abnormalities. Patients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as found in stage 3, and patients in stage 4 are comatose. In stage 4, there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.

A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize? A. The patient will obtain measurement of drainage from the T-tube. B. The patient will exercise three times a week. C. The patient will take immunosuppressive agents as required. D. The patient will monitor for signs of liver dysfunction.

C. The patient will take immunosuppressive agents as required. Rationale: The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no change of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as the patient would;t go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress these topics over the immunosuppressive drug regimen.

CAUTION

C:hange in bowel or bladder habits A: sore that does not heal U:nusual bleeding or discharge T:hickening or lump in breast or elsewhere I:ndigestion or difficulty swallowing O:bvious change in wart or mole N:agging cough or hoarseness

a nurse is reviewing the laboratory results of a client who was admitted with a history of multiple myeloma. the nurse should expect to find an increase in which of the following laboratory values? Absolute neutrophil count (ANC) Calcium Platelets WBCs

Calcium The nurse expect the calcium level of a client who has a history of multiple myeloma to increase due to the destruction of bone.

A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean? No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis Can't assess tumor or regional lymph nodes and no evidence of metastasis Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Explanation: Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.

Which of the following is commonly a warning sign for gastointestinal cancer? Cobblestone Mucosa Candida albicans (Oral Thrush) Change in Bowel or Bladder Habits Excessive Flatulence Biliary Colic C. Difficile (Associated Diarrhea)

Change in Bowel or Bladder Habits Delta Bowel-bowl A change in bowel or bladder habits is a common sign of colorectal cancer. Be sure to assess usual elimination patterns against new problematic ones.

CAUTION

Change in b/b A sore that doesn't heal Unusual bleeding/discharge Thickening/lumps in breast/elsewhere Indigestion/difficulty swallowing Obvious change in wart/mole Nagging cough/hoarseness

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?

Change in the client's handwriting and/or cognitive performance Explanation: The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.

A client comes into the emergency department with reports of abdominal pain. What should the nurse ask first?

Characteristics and duration of pain Explanation: A focused abdominal assessment begins with a complete history. The nurse must obtain information about abdominal pain. Pain can be a major symptom of gastrointestinal disease. The character, duration, pattern, frequency, location, distribution, and timing of the pain vary but require investigation immediately.

A nurse is planning care for a client who is postoperative following a thyroidectomy. Which of the following interventions should the nurse include in the plan?

Check the client's voice every 2 hr. Answer Rationale: The nurse should assess the client's voice every 2 hr to monitor for hoarseness,which is a manifestation of laryngeal nerve damage

A nurse is caring for a client who is 1 day postoperative following a transsphenoidal hypophysectomy. While assessing the client, the nurse notes a large area of clear drainage seeping from the nasal packing. Which of the following should be the nurse's initial action?

Check the drainage for glucose. Answer Rationale: A potential complication of hypophysectomy is cerebral spinal fluid (CSF) leakage. Fluid leakage from the nose is a sign that this complication has occurred. The first action the nurse should take using the nursing process is to assess the drainage for the presence of glucose, which would indicate that the drainage is CSF.

A nurse is caring for a client who is receiving cisplatic to treat bladder cancer, After several treatments, the client reports fatigue. Which of the following actions should the nurse take?

Check the results of the client's most recent CBC

a nurse is caring for a client who is receiving cisplatin to treat bladder cancer. after several treatments, the client reports fatigue. which of the following actions should the nurse take? Check the results of the client's most recent CBC. Assess the client for a hypersensitivity reaction. Evaluate the client for hypercalcemia. Examine the client for hepatomegaly.

Check the results of the client's most recent CBC. Rationale: The client might have anemia as a result of myelosuppression (bone marrow suppression) from the chemotherapy. If so, she might require treatment for the anemia (transfusion, medication) and the provider might have to delay further chemotherapy until her blood counts are higher.

A nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums?

Check the value of the client's current platelet count

a nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. which of the following actions should the nurse take when the client reports bleeding gums? Explain to the client that this is an expected adverse effect. Check the value of the client's current platelet count. Instruct the client to use an electric toothbrush. Have the client make an appointment to see the dentist.

Check the value of the client's current platelet count. The nurse should recognize that the bleeding is likely due to the adverse effect of the chemotherapy and needs to be evaluated further. Bleeding gums is a sign of thrombocytopenia (decreased platelet count) secondary to bone marrow suppression, which can be life-threatening in a client who is receiving chemotherapy.

A nurse is planning care for a client who has a new diagnosis of diabetes insipidus. Which of the following interventions should the nurse include in the plan of care?

Check urine specific gravity. Answer Rationale: The nurse should check the client's urine specific gravity to monitor urine concentration in a client who has diabetes insipidus. A client who has diabetes insipidus has a urine specific gravity of less than 1.005.

A nurse is planning to perform a blood transfusion for a client. Which of the following actions should the nurse plan to take? (Select all that apply.)

Check vital signs before transfusion. Insert an IV with a 19-gauge needle. Check the expiration date of the blood product with a second nurse

When examining the skin of a client who is dehydrated due to fluid losses from the gastrointestinal tract, which of the following would be most important?

Checking if the mucous membranes are dry Explanation: Mucous membranes may be dry, and skin turgor may be poor in clients suffering from dehydration as a result of fluid losses from the GI tract. Checking the skin for discoloration and inspecting the sclera if it is yellow is taken into consideration when the client could have symptoms of jaundice, not fluid losses. Distended abdominal veins are not associated with dehydration.

A nurse is assessing a client who is receiving a platelet transfusion. Which of the following findings is an adverse effect of the transfusion?

Chills Answer Rationale: Severe chills is an adverse effect of a platelet transfusion. The client might require premedication of diphenhydramine and acetaminophen to reduce this reaction.

A nurse is caring for a male client and the client discloses that the client has been living in a shelter for over 2 years. Which best describes the type of homelessness the client is experiencing? Chronic homelessness Acute homelessness Unstable homelessness Unsheltered homelessness

Chronic homelessness Explanation: A person is considered to be experiencing chronic homelessness when he or she spends more than a year in state of homelessness or has experienced a minimum of four episodes of homelessness over a three-year period. Sheltered homeless is when a person is living in a temporary or transitional housing operated by public and private agencies for individuals and families who have not stable housing. The unsheltered homeless live in places that are not used for housing such as cars, parks, abandoned building, tents, and or bus/train stations. There is no unstable homelessness.

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?

Chvostek's sign Answer Rationale: The nurse should suspect that the client has hypocalcemia, a possible complication following subtotal thyroidectomy. Manifestations of hypocalcemia include numbness and tingling in the hands, the soles of the feet, and around the lips, typically appearing between 24 and 48 hr after surgery. To elicit Chvostek's sign, the nurse should tap the client's face at a point just below and in front of the ear. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggesting neuromuscular excitability due to hypocalcemia.

The nurse is assessing a client with cirrhosis of the liver. Which stool characteristic would the nurse expect the client to report?

Clay-colored or whitish Explanation: Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract. The other stool colors would not be indicators of obstructive jaundice but may indicate other GI tract disorders.

A nurse is obtaining information from a veteran client in order to assess for index trauma. Which finding should alert the nurse to a potential problem? Client is a light sleeper and wakes easily. Client was discharged with honors from the service. Client doesn't identify any concerns about past military experiences. Client doesn't find pleasure in life experiences.

Client doesn't find pleasure in life experiences. Explanation: An index trauma represents either the worst event or closely related events that an individual has either undergone or witnessed. The client who doesn't find pleasure in life experiences is displaying anhedonia with detachment. All of the other options are not correlated with index trauma.

A nurse is teaching a class at a community center to a group of young adult, adult, and older adult clients regarding regular screening recommendations for cancer prevention. Which of the following information should the nurse include?

Clients should have a yearly test for fecal occult blood. Answer Rationale: According to the American Cancer Society, all clients should have a yearly test to check for fecal occult blood.

A client is scheduled for several diagnostic tests to evaluate gastrointestinal function. After teaching the client about these tests, the nurse determines that the client has understood the teaching when the client identifies which test as not requiring the use of a contrast medium?

Colonoscopy Explanation: A colonoscopy is a direct visual examination of the entire large intestine. It does not involve the use of a contrast agent. Contrast medium may be used with a small bowel series, computed tomography, and upper GI series.

Stage 4 Hepatic Encephalopathy

Comatose; absence of asterixis/DTR; flaccid extremities

GERD

Common disorder marked by backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus - EGD for diagnosis symptoms: Heartburn, radiating pain to neck/jaw/back Throat irritation, pain relieved by drinking

Which of the following is a risk factor for homelessness among persons with SPMI? Concurrent drug or alcohol abuse Adequate family support Presence of negative symptoms of schizophrenia Presence of a cognitive disorder

Concurrent drug or alcohol abuse Explanation: Risk factors for homelessness include presence of positive symptoms of schizophrenia, concurrent drug or alcohol abuse, presence of a personality disorder, lack of current family support, and high rate of disorganized family functioning from birth to age 18.

inflammatory bowel disease (crohns or UC) complications

Electrolyte imbalance Cardiac dysrhythmias GI bleeding with fluid loss Perforation of the bowel

ketoconazole

Cortcosteroid Inhibitor used in Cushing's Disease monitor hepatotoxicity!

big difference between DKA and HHS

HHS: no ketones in blood / urine, and normally they are not acidotic, and this is normally a slow burn DKA: ketones present, acidotic, and normally rapid onset

A nurse is working with a group of veterans to help improve racial/ethnic inclusion within the clinic setting. What strategy should the nurse implement? Select all that apply. Maintain strict appointment schedules. Maintain HIPAA confidentiality during client encounters. Create a focus group to identify client needs. Educate staff related to diversity concepts. Provide alternative therapies for mental health services.

Create a focus group to identify client needs. Provide alternative therapies for mental health services. Educate staff related to diversity concepts. Explanation: To help foster racial/ethnic inclusion, the nurse can create a focus group to identify client needs because this will help to avoid any unforeseen barriers. Providing alternative therapies for mental health, as well as educating staff related to diversity concepts, demonstrates integration of culture, worldview, and identity. Maintaining a strict appointment schedule may create additional barriers to access to health care. Maintaining HIPAA confidentiality is an expectation of clinical practice but does not directly help to improve racial/ethnic inclusion.

cushing's memory trick

Cushion of steroids HIGH Big, round, hairy

A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate? A. Infusion of intravenous heparin B. IV administration of albumin C. STAT administration of vitamin K by the intramuscular route D. IV administration of octreotide (Sandostatin)

D. IV administration of octreotide (Sandostation) Rationale: Octreotide (Sandostatin) a synthetic analog of the hormone somatostatin is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate control of variceal bleeding. Vitamin K and albumin are not administered and heparin would exacerbate, not alleviate, bleeding.

A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding? A. Similar liver size and texture as in younger adults B. A nonpalpable liver C. A slightly enlarged liver with palpably hard edges D. A slightly decreased size of the liver

D. A slightly decreased size of the liver Rationale: The most common age-related change in the liver is a decrease in size and weight. The liver is usually still palpable, however, it is not expected to have hardened edges.

A nurse is amending a patient's plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patient's care plan? A. Mobilization with assistance at least 4 times daily B. Administration of beta-adrenergic blockers as ordered C. Vitamin B12 injections as ordered D. Administration of diuretics as ordered

D. Administration of diuretics as ordered Rationale: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers are not used to treat ascites and bed rest is often more beneficial than increased mobility. Vitamin B23 injections are not necessary.

Which is an age-related change of the hepatobiliary system?

Decreased blood flow Explanation: Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in the size and weight of the liver.

A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine? A. The hepatitis A vaccine B. Albumin infusion C. The hepatitis A and B vaccines D. An immune globulin injection

D. An immune globulin injection Rationale: For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular administration of immune globulin during the incubation period, if given within 2 weeks of exposure. Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine provides protection against the hepatitis B virus, but plays no role in protection for the patient exposed to hepatitis A. Albumin confers no therapeutic benefit.

A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the patient's family how to safely perform which of the following actions? A. Aspirating bile from the catheter using a syringe B. Removing the catheter when output is 15 mL in 24 hours C. Instilling antibiotics into the catheter D. Assessing the patency of the drainage catheter

D. Assessing the patency of the drainage catheter Rationale: Families should be taught to provide basic catheter care, including assessment of patency. Antibiotics are not instilled into the catheter and aspiration using a syringe is contraindicated. The family would not independently remove the catheter; this would be done by a member of the care team when deemed necessary.

A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse should be aware that this catheter will facilitate which of the following? A. Continuous monitoring for portal hypertension B. Administration of immunosuppressive drugs during the first weeks after transplantation C. Real-time monitoring of vascular changes in the hepatic system D. Delivery of a continuous chemotherapeutic dose

D. Delivery of a continuous chemotherapeutic dose Rationale: In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump that delivers a continuous chemotherapeutic dose until completed. The hepatic artery catheter dose not monitor portal hypertension, deliver immunosuppressive drugs, or monitor vascular changes in the hepatic system

A female middle adult client tells a nurse that she tested positive for a mutant BRCA1 gene. The nurse should recognize that the client is at an increased risk for which of the following situations?

Developing breast cancer Answer Rationale: The BRCA1 gene is used to determine the probability of a client developing breast cancer. BRCA1 genetic testing is used for women who have a strong family history of breast cancer.

diagnosis of gastritis

Diagnosis is usually by UGI x-ray or endoscopy and biopsy

A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient's increased risk of bleeding. The nurse recognizes that this risk is related to the patient's inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function? A. Alterations in glucose metabolism B. Retention of bile salts C. Inadequate production of albumin by hepatocytes D. Inability of the liver to use vitamin K.

D. Inability of the liver to use vitamin K. Rationale: Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin.

A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringer's Lactate at 150 cc/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient? A. Arterial line B. Diuretics C. Foley catheter D. Volume expanders

D. Volume expanders Rationale: Because patients with bleeding esophageal varices have intravascular volume depletion and are subject to electrolyte imbalance, IV fluids with electrolytes and volume expanders are provided to restore fluid volume and replace electrolytes. Diuretics would reduce vascular volume. An arterial line and Foley catheter are likely to be ordered, but neither actively maintains the patient's volume.

A nurse is teaching a homeless female client about prevention of crime and violence. Which should be included in the teaching plan? Dangers of assaults and rape Healthy foods Suicide prevention Communication techniques

Dangers of assaults and rape Explanation: Homeless women should be taught the dangers of assaults, abuse, and rape and where they should go if this occurs. The client does not have a history of suicide attempts and is not thinking about hurting themselves, so suicide precaution is not a priority. Homeless persons are not concerned with nutrition. Communication techniques are not the priority.

hyperparathyroidism

Decalcification of bone renal calculi

purpose of gastrointestinal intubation

Decompress the stomach, Lavage the stomach (saline, charcoal) Diagnose GI disorders, Administer medications and feeding, to treat an obstruction, to compress a bleeding site (esophageal varices) to aspirate contents for analysis

Symptoms of SIADH

Decrease UOP, headache, weakness, hypervolemia, seizures/coma,

a nurse is reviewing the laboratory results of a client who has acute leukemia and received an aggressive chemotherapy treatment 10 days ago. which of the following hematologic laboratory values should the nurse expect? sata Decreased platelet count ​Increased hemoglobin count Decreased leukocyte count Increased platelet count Decreased erythrocyte count

Decreased platelet count Decreased leukocyte count Decreased erythrocyte count Decreased platelet count is correct. The nurse should expect to see a decreased platelet count due to bone marrow suppression from the chemotherapy treatment. Increased hemoglobin count is incorrect. The nurse should expect to see a decreased hemoglobin count due to bone marrow suppression from the chemotherapy treatment. Decreased leukocyte count is correct. The nurse should expect to see a decreased leukocyte count due to bone marrow suppression from the chemotherapy treatment. Increased platelet count is incorrect. The nurse should expect to see a decrease not increased platelet count due to bone marrow suppression from the chemotherapy treatment. Decreased erythrocyte count is correct. The nurse should expect to see a decreased erythrocyte count due to bone marrow suppression from the chemotherapy treatment.

diabetes insipidus (DI)

Deficiency of antidiuretic hormone (ADH), which causes the patient to excrete large quantities of urine (polyuria) and exhibit excessive thirst (polydipsia)

Diagnostic surgery (biopsy)

Definitive method for obtaining tissue to identify the cellular characteristics that influence all treatment decisions of possible neoplasm

a nurse is assessing a client who has diabetes insipidus. which of the following findings should the nurse expect? Dehydration Polyphagia Hyperglycemia Bradycardia

Dehydration Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration.

A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect?

Dehydration Answer Rationale: Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration

Individuals with serious and persistent mental illness (SPMI) face multiple and complex social problems that reduce their ability to maintain themselves in society. Which of the following statements is most true of deinstitutionalization? Deinstitutionalization has created a situation in which individuals with SPMI are commonly held within ER settings, instead of in the community where they belong. Deinstitutionalization creates difficulties for families because they now have to visit their loved ones within the sterile environments of state mental institutions. Deinstitutionalization since the 1960s has caused individuals with SPMI to be discharged into community settings that were ill equipped to handle their multiple and complex needs. Deinstitutionalization is no longer a large problem due to recent federal funding initiatives for community housing for those with SPMI.

Deinstitutionalization since the 1960s has caused individuals with SPMI to be discharged into community settings that were ill equipped to handle their multiple and complex needs. Explanation: Deinstitutionalization, the process by which large numbers of psychiatric-mental health clients were discharged from public psychiatric facilities, created an influx of seriously and persistently mentally ill clients back into the community to receive outpatient care. It is a major factor in the current problems of the mentally ill.

diagnosis of cancer

Determine presence, extent of tumor Identify possible spread (metastasis) of disease or invasion of other body tissues Evaluate function of involved, uninvolved body systems, organs Obtain tissue, cells for analysis, including evaluation of tumor stage, grade

While administering an intravenous chemotherapeutic medication to a client, the nurse assesses swelling at the insertion site. What is the nurse's first action? Administer a neutralizing solution. Discontinue the intravenous medication. Apply a warm compress. Aspirate as much of the fluid as possible.

Discontinue the intravenous medication. Explanation: If extravasation of a chemotherapeutic medication is suspected, the nurse must immediately stop the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.

A nurse is providing discharge teaching for a client who is postoperative following a simple mastectomy. The client is to begin outpatient radiation therapy the next day. Which of the following instructions about maintaining skin integrity should the nurse include?

Do not apply heat to the area of irradiation

A nurse is providing discharge teaching for a client who is postoperative following a simple mastectomy. The client is to begin outpatient radiation therapy the next day. Which of the following instructions about maintaining skin integrity should the nurse include?

Do not apply heat to the area of irradiation. Answer Rationale: This instruction will help the client avoid tissue damage. Radiated tissue becomes thinner and might lack tissue receptors that would otherwise alert the client to a potential burn injury. When outdoors in sunlight, the client should wear protective clothing over the area of irradiation.

A client receives a local anesthetic to suppress the gag reflex for a diagnostic procedure of the upper GI tract. Which nursing intervention is advised for this client?

Do not give any food and fluids until the gag reflex returns. Explanation: For a client receiving a local anesthetic that suppresses the gag reflex, the nurse is advised to withhold food and fluids until the reflex returns. The client is monitored for other symptoms specifically related to the procedure, but may not be monitored for cramping or abdominal distention or breathing-related discomforts unless reporting these symptoms. It is also not essential to monitor the client's fluid output for 24 hours, because the client is advised to avoid fluid or food intake until the reflex returns. However, the client may be monitored for any dehydration related to not consuming any fluids or food before the procedure.

A client with a gastrointestinal condition is prescribed a stool guaiac for fecal occult blood. Which instructions will the nurse provide the client about this test? Select all that apply. Drink orange juice for 2 days before the test. Do not take any aspirin for 72 hours before the test. Avoid ingesting red meat for 72 hours before the test. Take additional doses of vitamin C supplements before the test. Reduce the amount of nonsteroidal anti-inflammatory drugs taken.

Do not take any aspirin for 72 hours before the test. Avoid ingesting red meat for 72 hours before the test. Explanation: Guaiac based fecal occult blood testing (gFOBT) is one of the most commonly performed stool tests. It can be useful in initial screening for several disorders, although it is used most frequently in early cancer detection programs. The client should be advised to not take aspirin or eat red meat for 72 hours before the test because it could cause a false-positive result. The client should be advised to avoid ingesting anything that contains vitamin C such as orange juice and vitamin C supplements because it could cause a false-negative result. Nonsteroidal anti-inflammatory drugs should be avoided for 72 hours before the test.

A client is scheduled for magnetic resonance imaging (MRI). During the client teaching, what will the nurse discuss?

Do you experience any claustrophobia?" Explanation: MRI is a noninvasive technique that uses magnetic fields and radio waves to produce images of the area being studied. Clients must be NPO for 6 to 8 hours before the study and remove all jewelry and other metals. The examination takes 60 to 90 minutes and can induce feelings of claustrophobia, because the scanner is close fitting.

A nurse is assessing a client who will undergo abdominal surgery in 2 hr. The client reports being nervous about the surgery, last had food and fluids at 2330 the previous evening, and signed the surgical consent 2 days ago. Which of the following is an appropriate nursing action regarding these findings?

Document the findings in the client's medical record. Answer Rationale: Whenever a nurse collects data from a client, documentation is essential. However, in this case, all these findings are expectations for a client who is preoperative, so there is no need for the nurse to take any action other than documenting.

benign cells -- ability to cause death

Does not usually cause death unless its location interferes with vital functions.

benign cells -- tissue destruction

Does not usually cause tissue damage unless its location interferes with blood flow.

a nurse is creating the plan of care for a client who is immunosuppressed. which of the following precautions should the nurse include in the plan? sata Don a mask, gloves, and gown. Restrict visitors who have active infections. Limit the client from bathing daily. Instruct the client to eat cooked foods only. Dispose of all linen in the trash after use.

Don a mask, gloves, and gown. Restrict visitors who have active infections. Instruct the client to eat cooked foods only. Don a mask, gloves, and gown is correct. The nurse should wear a mask, gloves, and gown to protect the client from contacting an infection from bacteria or virus. Restrict visitors who have active infections is correct. The nurse should restrict visitors who have an active infection to protect the client. Limit the client from bathing daily is incorrect. The nurse should have the client bathe daily to clean bacteria off the skin that can cause an infection. Instruct the client to eat cooked foods only is correct. The nurse should instruct the client eat only cooked foods to protect the client from bacteria in raw foods. Dispose of all linen in the trash after use is incorrect. The nurse should place used linens in a linen bag to be washed.

treatment of acromegaly (growth hormone disorder) meds

Dopamine agonists/somatostatin analogs - inhibit GH release GH receptor blocker - prevents GH receptor activity/blocks production

A nurse is caring for a client admitted who reports increased urination and thirst. Medical History Client admitted with report of polyuria and polydipsia. Notable muscle twitching of upper extremities. Past medical history: Varicella as a child. No other health issues. Current medications: Occasional ibuprofen for pain. Family history: Father had history of nephrogenic diabetes insipidus Physical Examination Alert and oriented x 3. Client states that they have had difficulty concentrating lately and are irritable. Client reports occasional dizziness. Skin is warm, dry, and scaly.Mucous membranes dry and pink. Lungs clear to auscultation bilaterally. Abdomen soft, nondistended with active bowel sounds x 4. Denies nausea, vomiting, or diarrhea. Peripheral pulses +1. Twitching noted in upper extremities, client states they have had twitching "for some time." Diagnostic Results Basic metabolic profile Sodium 157 mEq/L (136 to 145 mEq/L) Potassium 4.0 mEq/L (3.5 to 5 mEq/L) Chloride 102 mEq/L (98 to 106 mEq/L) Magnesium 1.8 mEq/L (1.3 to 2.1 mEq/L) Total calcium 9.7 mg/dL (9.0 to 10.5 mg/dL) CBC with differential Total WBCs 6,500/mm3 (5,000 to 10,000/mm3) Neutrophils 60% (55% to 70%) Lymphocytes 30% (20% to 40%) Monocytes 5% (2% to 8%) Eosinophils 2.5% (1% to 4%) Basophils 0.7% (0.5% to 1%) Hemoglobin 21 g/dL (Male: 14 to 18 g/dL; Female: 12 to 16 g/dL) Hematocrit 55% (Male: 42% to 52%; Female: 37% to 47%) RBCs 5.7 x 106µL (Male: 4.7 to 6.1 x 106µL; Female: 4.2 to 5.4 x 106µL Nurses' Notes 0845:Needed assistance to the bathroom, reports dizziness.Urine output 1,500 mL. Assisted client to bed. Vitals taken.V ital Signs 0800:Temperature 37.4° C (99.4° F) Heart rate 100/min Respiratory rate 22/min Blood pressure 108/78 mm Hg Oxygen saturation 98% on room air 0900: Temperature 37.4° C (99.4° F) Heart rate 104/min Respiratory rate 22/min Blood pressure 96/70 mm Hg Complete the following sentence by using the lists of options. The nurse should first address the client's Select... followed by the client's Select....

Drop Down 1 Blood pressure is correct. A decreased blood pressure can indicate that this client is at risk for hypovolemia due to the client's polyuria and decrease in fluid volume; therefore, this is the priority finding. Drop Down 2 Sodium level is correct. After the nurse has addressed the client's blood pressure, the nurse should then address client's elevated sodium level. With increased sodium levels, more sodium is able to move rapidly across cell membranes during depolarization, causing tissues to be easily excited. Actions need to be taken to decrease the client's sodium level. Therefore, this finding is the nurse's priority to address.

Which of the following is commonly a warning sign for gastointestinal cancer? C. Difficile (Associated Diarrhea) Discharge Dyspepsia (Indigestion) Metallic taste Biliary Colic Cobblestone Mucosa

Dyspepsia (Indigestion) Disc-pop Indigestion or difficulty swallowing (dysphagia) may indicate cancer of the mouth, throat, esophagus, or stomach.

A nurse is caring for a client who is scheduled to receive external radiation to the neck for cancer of the larynx. During a pre-treatment exam, the nurse explains to the clients the most likely side effect would be

Dysphagia

ulcerative colitis

Edema/inflammation rectum/rectosigmoid colon complications: Abscess, obstructions occur

nursing care of patients with IBD (crohns or UC)

Educate regarding the usual course of the disease process, medication therapy and vitamin supplements. Monitor by colonoscopy due to the increased risk of colon cancer. Assist the client in identifying foods that trigger manifestations. Monitor for electrolyte imbalance, especially potassium. Diarrhea can cause a loss of fluids and electrolytes. Monitor I&O, and assess for dehydration. Educate the client to eat high-protein, high-calorie, low-fiber foods. Seek emergency care for indications of bowel obstruction or perforation

A nurse working with a veteran client diagnosed with PTSD and who has a prior suicide attempt is concerned about the client's present mental health status. Which nursing action would best help to support the client? Encourage the client to go to the library to read. Educate the client about available support systems. Obtain a referral for home health visits. Ask the client about activity preferences.

Educate the client about available support systems. Explanation: A veteran client with a prior suicide attempt should be offered a safe therapeutic environment and be made aware of available support systems to foster engagement. Encouraging the client to go the library to read is a great activity but does not specifically address the client's mental status. Obtaining a referral for home visits does not address the current mental health status but may be needed for follow-up. Asking the client about activity preference does not address the current mental health status.

The family members of a client with posttraumatic stress disorder (PTSD) state that they are "constantly walking on eggshells" because the client reacts so strongly to stressors that seem inconsequential to them. What is the nurse's best response? Educate the family about the need to set limits assertively but empathically Educate the family about the client's hyperarousal Arrange for respite so that the family can have their emotional needs met Assess each member of the family for signs and symptoms of PTSD

Educate the family about the client's hyperarousal Explanation: The client is likely in a state of hyperarousal and educating the family about this phenomenon would be a useful starting point. There is no obvious need for the family to focus on setting limits with the client. Similarly, there is no clear indication of caregiver burnout that would necessitate respite. The family members' sentiment does not indicate a risk of PTSD.

A nurse is caring for a client following surgical treatment for a supratentorial brain tumor. Which of the following interventions should the nurse take?

Elevate the head of the bed to 30°. Answer Rationale: The client who has surgery to treat a supratentorial brain tumor is at risk for increased intracranial pressure (ICP). Elevation of the head of the bed to 30° assists in promoting venous and CNS fluid drainage from the head to prevent increased ICP

hyperparathyroidism diagnostics

Elevated serum calcium

Treatment of hepatic encephalopathy

Eliminate precipitating cause Medications: - Lactulose: traps/expels ammonia - Metronidazole or Rifaximin: reduce ammonia producing GI bacteria

A nurse is planning care for a client who states he is anxious concerning abdominal surgery. Which of the following actions should the nurse take?

Encourage the client to express negative emotions. Answer Rationale: The nurse is acknowledging the client's negative emotions, therefore providing open therapeutic communication.

A nurse is working with a veteran client diagnosed with posttraumatic stress disorder (PTSD). The client is becoming apprehensive when talking about military life. How should the nurse best respond? Tell the client that these feelings will subside in a few minutes. Encourage the client to take a moment to breathe. Switch the topic of the conversation. Continue the conversation and offer support.

Encourage the client to take a moment to breathe. Explanation: The client is experiencing physiological reactivity when being reminded of the event. The nurse should encourage the client to take a moment to breathe. Continuing the conversation, even with offering of support, will not address this symptomatic presentation of PTSD. Telling the client that these feelings will subside in a few minutes or switching the topic of the conversation can lead to further agitation and/or be perceived as lack of support.

A nurse is caring for a client who has just been diagnosed with cancer of the colon. The client asks the nurse several questions about what the provider might be planning to do. Which of the following nursing responses should the nurse make?

Encourage the client to write down questions to ask the provider. Answer Rationale: The nurse does not know the answers to the client's questions, so helping the client to prepare questions for the provider addresses the client's concerns.

The nurse is caring for a client suspected of having stones that have collected in the common bile duct. What test should the nurse prepare the client for that will locate these stones?

Endoscopic retrograde cholangiopancreatography (ERCP) Explanation: ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder.

peptic ulcer

Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus

malignant cells -- ability to cause death

Eventually causes death unless growth can be controlled

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue? Incisional biopsy Excisional biopsy Punch biopsy Needle biopsy

Excisional biopsy Explanation: Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.

A client with posttraumatic stress disorder (PTSD) has been unable to have restful sleep since being the victim of a robbery and assault. What should the nurse recommend? Temporarily moving to a new bedroom, if possible Exercising regularly, but not close to bedtime Adopting later times for going to bed and waking up Limiting naps to times earlier than 3:00 p.m.

Exercising regularly, but not close to bedtime Explanation: Exercise enhances sleep, but the hours within 3 hours of bedtime should be avoided. Naps should be avoided completely. Choosing new bedtimes and a new bedroom are not actions that are noted to improve sleep hygiene.

The nurse is providing care for a client whose history of intimate partner violence has resulted in posttraumatic stress disorder (PTSD). The client has few friends and states that the client is estranged from the client's family. How can the nurse best enhance the client's social support? Provide the client with educational resources that promote the client's self-worth Facilitate the client's participation in a support group Facilitate a meeting between the client and the client's family members Encourage the client to make new friends

Facilitate the client's participation in a support group Explanation: A support group can be a valuable source of social support. If the client states that the client is estranged from the client's family, it would be inappropriate for the nurse to independently broach this barrier. Making new friends is difficult for a client experiencing PTSD. Educational resources can be valuable but are not a substitute for social support.

When explaining dissociative disorders to a client, what feature of these disorders would a nurse describe? Failure to integrate identity, memory, and consciousness Overuse of sedatives like alcohol Total amnesia of the events that caused the disorder Disinhibited social engagement, being overly friendly with strangers

Failure to integrate identity, memory, and consciousness Explanation: The essential feature of these disorders involves a failure to integrate identity, memory, and consciousness. That is, unwanted intrusive thoughts disrupt one's contact with the here and now, or memories that are normally accessible are lost. These disorders are closely related to trauma- and stressor-related disorders but are categorized separately.

A nurse is preparing a client for a radiation treatment who is postoperative following a mastectomy. The nurse should inform the client to expect which of the following adverse effects from the treatment?

Fatigue Answer Rationale: The nurse should inform the client to expect fatigue with her radiation treatment. Fatigue occurs regardless of the radiation target site.

symptoms of hypothyroidism

Fatigue, cold intolerance, constipation, weight gain, apathy, bradycardia/hypotension

A nurse is caring for a client who is two days postoperative following creation of an ileal conduit. Which of the following is an unexpected finding associated with this procedure?

Feces in the drainage appliance Answer Rationale: Feces in the drainage appliance is an unexpected finding associated with this procedure. The ileal conduit procedure incorporates implantation of the ureters into a portion of the ileum that has been resected from its anatomical position and now functions as a reservoir or conduit for urine. Feces should not be draining from the conduit.

A nurse is caring for a client who is two days postoperative following creation of an ileal conduit. Which of the following is an unexpected finding associated with this procedure?

Feces in the draining appliance

Which of the following are examples of transitional housing? Select all that apply. Hospitalization Halfway houses Short-stay residences Group homes Nursing homes

Halfway houses Group homes Short-stay residences Explanation: Transitional housing may consist of a halfway house, a short-stay residence or group home, or a room at a hotel designated for people who are homeless. Hospitalization and nursing home placement are not considered types of transitional housing.

A nurse is working with a social worker to find a homeless shelter for a man and two young daughters. What is the priority for shelter placement for this family? Allow the social worker to find placement for the family. Find a shelter to accommodate the family. Hospitalize the father for an acute problem to keep the family together. Separate the father and children into two shelters.

Find a shelter to accommodate the family. Explanation: Family homelessness has a adverse effect on children. The nurse should assist the social worker to find placement for the entire family. The family should be kept together to minimize trauma to the children. Hospitalizing the father can separate the children. The nurse should work together with the social worker.

hepatitis symptoms

Flu like symptoms, fever, dark urine, vomiting, jaundice

hyperglycemic hyperosmolar syndrome treatment

Fluid rehydration (NS, ½ NS, dextrose), IV insulin, K+ replacement Frequent glucose checks, cardiac monitoring, Start SQ insulin before stopping IV insulin give IV insulin until BS <200

dka treatment

Fluid rehydration (NS, ½ NS, dextrose), IV insulin, K+ replacement Frequent glucose checks, cardiac monitoring, Start SQ insulin before stopping IV insulin give IV insulin until: BS <200, pH >7.3, bicarb >18, anion gap <12 (NA - (Cl + HCO2/CO2))

a nurse is preparing to administer three liquid medications to a client who has an NG feeding tube with continuous enteral feedings. which of the following actions should the nurse take? Mix the three medications together prior to administering. Dilute each medication with 10 mL of tap water. Maintain the head of the bed in a flat position for 30 min following medication administration. Flush the NG feeding tube with 30 mL of water immediately following medication administration

Flush the NG feeding tube with 30 mL of water immediately following medication administration The nurse should flush the NG feeding tube with 15 to 60 mL of sterile water following medication administration to ensure the feeding tube is cleared of the medications.

The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? Use disposable utensils for the next month. Shield your throat area when near others. Prepare food separately from family members. Flush the toilet several times after every use.

Flush the toilet several times after every use. Explanation: Iodine 131 is a systemic internal radiation that is excreted through body fluids, especially urine. Flushing the toilet several times after each use will avoid the exposure of others to radioactive exposure. Shielding the throat area is not effective because this form of treatment is systemic. Preparing food separately is not necessary, but use of separate eating utensils will be necessary for the first 8 days.

how to prevent hyperglycemia, hypoglycemia, and/or vitamin deficiencies in parenteral nutrition

Frequent accuchecks (q 4-6) Possibly need to have D5 nearby

A nurse is planning care for a client who is being treated with chemotherapy and radiation for metastatic breast cancer, and who has neutropenia. The nurse should include which of the following restrictions in the client's plan of care?

Fresh flowers and potted plants in the room Answer Rationale: Clients who are receiving chemotherapy and radiation therapy are likely to become immunocompromised as a result of neutropenia, a decreased white blood cell (WBC) count. Because micro-organisms are likely to be present on fresh flowers and plants, immunocompromised clients are instructed not to accept such gifts into the room. In addition, the client is instructed to eat only thoroughly cooked meats and thoroughly washed fruits and vegetables. Immunocompromised clients are more susceptible to infection and illness from food- borne bacteria than other clients.

malignant cells -- metastasis

Gains access to the blood and lymphatic channels and metastasizes to other areas of the body or grows across body cavities such as the peritoneum.

complications of cholecystitis

Gallbladder rupture

A client is being scheduled for a gastric analysis test. The nurse knows that which conditions can be diagnosed from this type of test? Select all that apply. Gastric ulcer Gastric cancer Duodenal ulcer Pernicious anemia Esophageal strictures

Gastric ulcer Gastric cancer Duodenal ulcer Pernicious anemia Explanation: Analysis of the gastric juice yields information about the secretory activity of the gastric mucosa and the presence or degree of gastric retention in clients thought to have pyloric or duodenal obstruction. Important diagnostic information to be gained from gastric analysis includes the ability of the mucosa to secrete hydrochloric acid. This ability is altered in various disease states, including gastric ulcer, gastric cancer, duodenal ulcer, and pernicious anemia. The ability to secrete hydrochloric acid is not altered in esophageal strictures.

areas of chemotherapy toxicity

Gastrointestinal Hematopoietic Renal Cardiopulmonary Reproductive Neurologic Cognitive Fatigue

DKA diagnosis

Glucose >300, possible Na/K abnormalities, BUN >30, Creatinine > 1.5, ketones in urine / blood pH <7.35, Na bicarb 0-15, bicarbonate 1-15

Hyperglycemic Hyperosmolar State (HHS) diagnostics

Glucose >600, possible Na low/normal, K+ normal/high, BUN >30, Creatinine > 1.5, osmolarity >320, pH >7.4, bicarbonate >20

To promote sleep hygiene, the nurse should encourage the PTSD client to incorporate which strategies into their routine? Select all that apply. Avoid drinking alcohol Enjoy a cup of caffeinated tea in the midafternoon if one gets sleepy. Exercise within 2 hours of bedtime will make you tired and you will fall to sleep faster Go to bed at a regular time nightly. Sleep in during the mornings when he had a restless night of sleep.

Go to bed at a regular time nightly. Avoid drinking alcohol Explanation: Some persons with PTSD find that they cannot sleep in their bed but can sleep in a chair. Some of the following strategies may be helpful: (1) Establish and maintain a regular bedtime and rising time; (2) Avoid naps; (3) Abstain from alcohol. Although alcohol may assist with sleep onset, an alerting effect occurs when it wears off; (4) Refrain from caffeine after midafternoon. Avoid nicotine before bedtime and during the night. Caffeine and nicotine are strong stimulants and cause fragmented sleep; and (5) Exercise regularly, avoiding the 3 hours before bedtime.

hypoparathyroidism treatment

Goal Ca 9-10. Give Ca, magnesium and vit D. Thiazine decrease Ca excretion

big problem with allogenic bone marrow transplants

Graft-Vs-Host-Disease

a nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. when the nurse finds the client's blood glucose to be 48 on the glucometer, he should give the client which of the following? Graham crackers 1 tsp sugar 4 oz diet soda 4 oz skim milk

Graham crackers After establishing that the client has hypoglycemia, the nurse should give the client about 15 g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of skim milk, 3 tsp of sugar or honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes.

malignant cells -- mode of growth

Grows at the periphery and overcomes contact inhibition to invade and infiltrate surrounding tissues

treatment of peptic ulcers

H2 receptor antagonists PPIs antacids mucosal protectants Antibiotic therapy lifestyle changes occasionally surgery

assessment of patients with IBD (crohns or UC)

Health history to identify onset, duration and characteristics of pain, diarrhea, urgency, tenesmus, nausea, anorexia, weight loss, bleeding, and family history Discuss dietary patterns, alcohol, caffeine, and nicotine use Assess bowel elimination patterns and stool Abdominal assessment

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction?

Hemolytic Explanation: Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in clients with hemolytic transfusion reactions and other hemolytic disorders. Obstructive and hepatocellular jaundice are the result of liver disease. Nonobstructive jaundice occurs with hepatitis.

A nurse is caring for a client who is postoperative following a transurethral resection of the prostate. Which of the following complications is the priority for the nurse to monitor for?

Hemorrhage Answer Rationale: Using the airway breathing circulation (ABC) approach to client care the nurse determines that the priority complication to monitor for is the client hemorrhaging; therefore, the nurse should monitor the client's urinary output for blood clots and bright red blood tinged urine following surgery.

thyroidectomy complications

Hemorrhage - Monitor dressing, change if needed, report bleeding Thyroid storm - Overwhelming thyroid hormones. High mortality. Hyperthermia, hypertension, ECG/mental changes - ABCs, Tylenol, cooling, fluids Airway obstruction - Bleeding/tracheal collapse/edema - Trach kit at bedside, high fowlers Hypocalcemia - Trousseau sign (hand), Chvostek sign (face) - IV calcium gluconate Nerve damage - Vocal cord paralysis - Speak q 2 hours

esophageal varices symptoms

Hemorrhage, hypovolemia, shock, hemoptysis, hematemesis

A nurse is interviewing a client. The client states that they have been staying at a relative's home until they can rent a place. The client has a job. What is the client at risk for? Domestic violence Limited life skills Low self-esteem Homelessness

Homelessness Explanation: There are a variety of causes of homelessness. These include poverty, lack of affordable housing, mental illness or substance abuse, low-paying jobs, domestic violence, eviction for not paying rent, limited life coping skills, veteran skills, and prison release. The client has been living with a relative, which is a sign of a lack of affordable housing. The nurse should recognize this cause and screen the client for risk of homelessness. The client is not experiencing domestic violence, limited life skills, or low self-esteem.

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

Hepatic encephalopathy Explanation: Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations?

Hepatic encephalopathy Explanation: The earliest symptoms of hepatic encephalopathy include minor mental changes and motor disturbances. The client appears slightly confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and have restlessness and insomnia at night. As hepatic encephalopathy progresses, the client may become difficult to awaken and completely disoriented with respect to time and place. With further progression, the client lapses into frank coma and may have seizures. Simple tasks, such as handwriting, become difficult.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

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

A client with abdominal pain is scheduled for a CT scan of the abdomen with contrast. Which assessment will the nurse complete before transporting the client for the diagnostic test?

History of allergies Explanation: A CT scan provides cross-sectional images of abdominal organs and structures. A CT scan may be performed with or without oral or intravenous (IV) contrast, but the enhancement of the study is greater with the use of a contrast agent. A common risk from IV contrast agents is allergic reactions; therefore, the client must be screened for this risk. Any allergies to contrast agents, iodine, or shellfish must be determined before administration of a contrast agent. Clients allergic to the contrast agent may be premedicated with a corticosteroid and antihistamine. Therefore, a history of allergies must be completed before the test. Assessing for the presence of a cochlear implant is recommended before magnetic resonance imaging (MRI), but not before a CT scan. The last use of an oral laxative and current list of prescribed medications are not required before a CT scan of the abdomen.

A nurse is interviewing a client to gather information for a health assessement. Which risk factors identified by the nurse would contribute to homelessness? Select all that apply. Addicted to alcohol Has two biological children History of depression Unemployed Maintains a driver's license

History of depression Addicted to alcohol Unemployed Explanation: Homelessness has no single cause but has risk factors. Many factors, including unemployment, lack of skills, mental illness, substance abuse, and domestic violence, may cause the person or family to lose permanent housing. Having a driver's license or children are not risk factors that can cause a person or family to be homeless.

A nursing instructor is teaching a class about substance abuse and identifies which of the groups as having the highest rate of substance abuse? Homeless Elderly College students Pregnant women

Homeless Explanation: Substance abuse is much more common among homeless people than the general population.

Homeless clients have barriers to health and hospital care. What are some of the barriers? Select all that apply. Homeless client do not have access to insurance coverage. Homeless clients have access to hospitals to receive medical care. Homeless clients have an ability to carry out treatment recommendations. Homeless clients focus on survival as the priority. Homeless clients do not have money to pay for health care.

Homeless clients do not have money to pay for health care. Homeless client do not have access to insurance coverage. Homeless clients focus on survival as the priority. Explanation: There are a variety of barriers to health and hospital care for homeless clients. Cost and lack of insurance as well as the inability of this population to carry out treatment recommendation. Homeless clients have survival as their first priority. Compliance with medication and treatment regimens is difficult because successful treatment requires collaboration, monitoring, time for medication, and a secure place to keep medication.

esophageal varices

Impaired hepatic circulation causes varices in stomach/esophagus which can bleed easily

A nurse is teaching a group about homelessness. Which statement by a member of the group identifies a need for additional teaching? Homelessness is a lack of fixed nighttime residence. Homelessness is a permanent situation. Homelessness can be either sheltered or unsheltered. Homelessness can affect an individual or families.

Homelessness is a permanent situation. Explanation: Homelessness is a lack of a fixed, regular, and adequate nighttime residence, which includes places not designed for or ordinarily used as a regular sleeping accommodation (car, park, abandoned building, bus/train station) as well as publicly or privately operated shelters or transitional housing, including a hotel or motel paid for by government or charitable organization. Homelessness can be considered as either shelter or unsheltered. The homeless population include people of all ages, economic levels, racial and cultural backgrounds, and geographic areas. Homelessness in not permanent.

A nurse is teaching a community group about the homeless and mentally ill clients. Which statement by a member of the class needs additional instruction? There are a variety of risk factors, such as societal and family issues, that can cause homelessness. Homelessness is an epidemic. Mental health issues can lead to homelessness. Clients who are homeless have an inability to cope or manage family, community, or groups.

Homelessness is an epidemic. Explanation: There are a variety of individual risk factors that affect the homeless and mentally ill. Homelessness is not an epidemic. Exposure to traumatic events and victimization can be a risk factor for homelessness. Societal factors such as single-parent families, dependent children, child in a foster home, racial or ethnic minority, veteran status, single men and women, and ex-offender released from jail or prison can cause homelessness. Symptoms of mental illness can result in conflicts with family, employers, landlords, and neighbors and lead to homelessness.

A nurse is teaching for a client who is to begin taking Tamoxifen to treat breast cancer. The nurse should instruct the client to expect which of the following findings as an adverse effect of the medication?

Hot flashes

a nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. which of the following findings should the nurse expect? Hyperpigmentation Intention tremors Hirsutism Purple striations

Hyperpigmentation Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.

treatment of acromegaly (growth hormone disorder) surgical

Hypophysectomy (remove pituitary gland) after surgery, they will have to have lifelong hormone replacement of all other pituitary hormones

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia?

Hypotension Explanation: Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased blood pressure; and decreased urine output.

Addisonian crisis treatment

IVF (replace sodium) and supplement diet with additional salt for GI losses hydrocortisone bolus, then continuous drip (replace the missing steroid hormones) tx hyperkalemia; give diuretic for K+, kayexalate, insulin with dextrose if acidotic, give bicarb place patient in a recumbent position with legs elevated replace glucose with glucagon vasopressors if hypotension persists antibiotics if infection caused the adrenal crisis

A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patients increased risk of bleeding. The nurse recognizes that this risk is related to the patients inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function? A) Alterations in glucose metabolism B) Retention of bile salts C) Inadequate production of albumin by hepatocytes D) Inability of the liver to use vitamin K

Inability of the liver to use vitamin K Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin.

GERD: incidence

Incidence seems to increase: -With aging patients -With irritable bowel syndrome and obstructive airway disorders (asthma, COPD, cystic fibrosis) -Barrett esophagus peptic ulcer disease and angina

A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock?

Increase in the heart rate from 88 to 110/min. Answer Rationale: Hypovolemic shock is a condition in which the heart is unable to supply enough blood to the body because of blood loss or inadequate blood volume. In an effort to compensate for this, the heart rate increases steadily. In the first stage of shock (compensatory), the heart rate is > 100/min. As shock progresses, the heart rate continues to accelerate to more than 150/min. In the final (irreversible or refractory) stage, the heart rate becomes very erratic and may develop asystole.

symptoms of acromegaly (growth hormone disorder)

Increase organ size (jaw, bones, hands/feet, organs), HTN, DM, increased ICP Gradual onset with no height increase

Stage 2 Hepatic Encephalopathy

Increased drowsiness/disorientation; inappropriate behavior/mood swings; asterixis, fetor hepaticus

Gastrin has which of the following effects on gastrointestinal (GI) motility?

Increased motility of the stomach Explanation: Gastrin has the following effects on GI motility: increased motility of the stomach, excitation of the colon, relaxation of ileocecal sphincter, and contraction of the gastroesophageal sphincter.

what does aldosterone do

Increases reabsorption / conservation of sodium and increases secretion of potassium

A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer? Chronic ache or pain Rash Persistent nausea Indigestion

Indigestion Explanation: Indigestion is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn't one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.

crohn's disease

Inflammation/ulceration of GI tract @ distal ileum complications: Fistulas common

A client is scheduled for an upper gastrointestinal barium study. Which teaching will the nurse provide for the client to prepare for this diagnostic test?

Ingest nothing by mouth after midnight. Explanation: An upper GI fluoroscopy delineates the entire GI tract after the introduction of a contrast agent such as barium. To prepare for the test, the client should be instructed to ingest nothing after midnight before the test. Clear liquids are not permitted the morning of the test. Most oral medications are withheld the morning of the test, but not for 24 hours before. There is no reason to avoid products containing aspirin for a week before the test.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? Administering aspirin if the temperature exceeds 102° F (38.8° C) Inspecting the skin for petechiae once every shift Providing for frequent rest periods Placing the client in strict isolation

Inspecting the skin for petechiae once every shift Explanation: Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

A nurse is caring for a patient with prostate cancer. The nurse should expect the provider to prescribe which of the following medications?

Leoprolide

Hepatic encephalopathy symptoms

Lethargy sleepiness mood swings asterixis fetor breath progress to coma

A nurse tells a new graduate that a shift in the mental health care system contributed greatly to increased rates of homelessness. To what change is the nurse referring? Focus on the comorbidity of substance abuse Institutional to community orientation Community to institutional orientation Focus on the comorbidity of mental illness

Institutional to community orientation Explanation: The current mental health care system has shifted from an institutional to a community orientation. Resulting gaps in care have contributed to increased rates of homelessness. The system has not adequately addressed the comorbidity of mental illness or substance abuse.

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The health care provider begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?

Intrinsic factor Explanation: Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? It treats cancer with lymph node involvement. It removes an entire lesion and the surrounding tissue. It is used to remove cancerous cells using a needle. It removes a wedge of tissue for diagnosis.

It removes a wedge of tissue for diagnosis. Explanation: The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the liklihood of liver problems? Select all that apply. jaundice petechiae ecchymoses cyanosis of lips aphthous stomatitis

Jaundice Petechiae Ecchymoses Explanation: The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema. Cyanosis of the lips is indicative of a problem with respiratory or cardiovascular dysfunction. Aphthous stomatitis is a term for mouth ulcers and is a gastrointestinal abnormal finding.

A nurse is planning care for a client who is to undergone a stem cell transplant.Which of the following actions should the nurse plan to take?

Keep blood pressure equipment in the client's room. Answer Rationale: The nurse should keep and use dedicated equipment, such as blood pressure monitor, stethoscope and thermometer in the client's room to prevent the spread of infection from client to client.

Hepatic encephalopathy

LIFE THREATENING Ammonia increases causing neurologic changes

symptoms of ulcerative colitis

LLQ pain/cramping; Anorexia/wt loss Mucus, blood, or pus in stool Rectal bleeding Abd distention, tenderness, firmness; high pitched bowel sounds

cushing's diagnostics

Labs: Elevated cortisol, ACTH (if disease), salivary cortisol, sodium, glucose Decreased potassium and calcium Dexamethasone suppression test

hyperthyroidism diagnosis

Labs: Free T4, T4 total, T3, - elevated TSH - decreased in graves Imaging, ultrasound

Diagnosis of hypothyroidism

Labs: TSH - increased in primary hypothyroidism decreased in secondary hypothyroidism T3, T4 - decreased ECG, thyroid scan

SIADH diagnosis

Labs: Urine - all levels will be concentrated (high SG, osmolality, pH, Na, K); blood - all levels will be diluted (osmolality, hgb/hct, Na, K)

diabetes insipidus diagnosis

Labs: Urine - all values will be diluted (low SG, osmolality, pH, Na, K); blood - all concentrated (osmolality, hgb/hct, super elevated Na, K) Water deprivation test - vasopressin sq if urine concentration increases = primary DI

addison's disease diagnostics

Labs: increased: K+, WBC, Ca+, BUN, Creatine; Decreased: Na, cortisol; Glucose: normal to decreased ACTH stimulation test Diagnostic tests: imaging, ECG

Diagnosis of cholecystitis

Labs: WBC, bili, amylase/lipase, AST/LDH Imaging: US, MRI, Hepatobiliary scan (HIDA), endoscopic retrograde cholangiopancreatography (ERCP)

causes of hyperglycemic hyperosmolar syndrome

Lack of sufficient insulin, undiagnosed DM 2, dehydration, infection, stress, medications (glucorticoids, thiazide diuretics, phenytoin, beta blockers, calcium channel blockers).

Chemotherapy Extravasation

Leaking of an antineoplastic drug into surrounding tissues during IV administration --> permanent damage to nerves, tendons, muscles; loss of limbs --> skin grafting or amputation may be necessary

A decrease in circulating white blood cells (WBCs) is referred to as Neutropenia Granulocytopenia Thrombocytopenia Leukopenia

Leukopenia Explanation: A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low absolute neutrophil count.

a nurse is planning care for a cleint who has leukemia and a platelet count of 130,000/mm. which of the following interventions should the nurse include in the plan of care? Check the IV site for bleeding every 8 hr. Limit IM injections. Obtain a rectal temperature every 8 hr. Check the client for proteinuria.

Limit IM injections. The nurse should plan to limit IM injections or venipunctures to prevent harm to the client. If venipuncture is necessary, the nurse should hold pressure to the site for 10 min afterward.

A nurse is planning care for a client who has immunosuppression following chemotherapy. Which of the following interventions should the nurse include in the plan of care?

Limit the number of health care workers entering the room. Answer Rationale: The nurse should limit the number of health care workers entering the client's room to prevent possible overexposure to microorganisms that can lead to an infection.

A nurse is planning care for a client who has an absolute neutrophil count (ANC) less than 1,000/mm^3. Which of the following interventions should the nurse include in the plan?

Limit visitors to healthy adults

A nurse is planning care for a client who has an absolute neutrophil count (ANC) less than 1,000/mm3. Which of the following interventions should the nurse include in the plan?

Limit visitors to healthy adults. Answer Rationale: The expected reference range of absolute neutrophil count is 2500 to 8000/mm3. This client has a reduced absolute neutrophil count (neutropenia) and is immunosuppressed. A client who has neutropenia is at an increased risk for infection. The nurse should restrict visitors for a client who has neutropenia to healthy adults to reduce the risk for infection.

side effects of radiation

Limited to areas of exposure Skin changes and hair loss usually permanent Care of patient receiving radiation includes: oTeaching oDon't remove radiation markings oSkin care to radiated areas oNo lotions or creams, use radigel provided by radiologist

While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which structure?

Liver Explanation: The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

A client with right upper quadrant pain and weight loss is diagnosed with liver cancer. For which treatment will the nurse prepare the client when it is determined that the disease is confined to one lobe of the liver?

Liver resection Explanation: Surgical resection is the treatment of choice when liver cancer is confined to one lobe of the liver and the function of the remaining liver is considered adequate for postoperative recovery. The use of external-beam radiation for the treatment of liver tumors has been limited by the radiosensitivity of normal hepatocytes and the risk of destruction of normal liver parenchyma. Studies of clients with advanced cases of liver cancer have shown that the use of systemic chemotherapeutic agents leads to poor outcomes. Laser hyperthermia has been used to treat hepatic metastases.

hypothyroidism complications

Myxedema Coma - LIFE THREATENING causes: untreated or poorly managed hypothyroidism, onset of stressors ABCs, neuro status (can slip into coma), keep warm, IVF, levothyroxine bolus, treat electrolytes

meds for SIADH

Loop diuretics, hypertonic sodium chloride, vasopressin antagonist (tolvaptan)

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?

Loss of 2.2 lb (1 kg) in 24 hours Explanation: Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

an older client reports difficulty chewing and swallowing. Which age-related changes will the nurse suspect as the reasons for the client's symptoms? Select all that apply. Loss of teeth Weakened gag reflex Atrophy of taste buds Reduced saliva production Less ptyalin and amylase in saliva

Loss of teeth Weakened gag reflex Atrophy of taste buds Reduced saliva production Less ptyalin and amylase in saliva Explanation: Age-related changes to the oral cavity and pharynx can cause difficulty chewing and swallowing. These changes include a loss of teeth, atrophy of taste buds, reduced saliva production, less ptyalin and amylase in saliva, and a weakened gag reflex.

nursing interventions for hyperthyroidism

Low stimulation, eye protection, cool shower, monitor temp, ECG, no palpation

management of GERD

Low-fat diet Avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages Avoid eating or drinking 2 hours before bedtime Elevate the head of the bed by at least 30 degrees Early identification/treatment to prevent dysplagia. Untreated develops Barrett's (precancerous cells) Possible Surgery

Myocardial Infarction vs GERD: Indigestion Dyspnea Eructation Hoarseness Nausea

MI: indigestion dyspnea nausea GERD: indigestion eructation hoarseness nausea

M (distant metastasis)

MX: Distant metastasis cannot be evaluated M0: No distant metastasis M1: Distant metastasis is present

A nurse is planning postoperative care for a client who is scheduled for an ileal conduit procedure. The nurse should include which of the following in the client's plan of care? (Select all that apply).

Maintain the client on a fluid restriction. Apply skin barrier around the stoma site. Educate the client that hematuria is expected following the procedure. Monitor hourly urine output.

A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal?

Maintaining the airway Explanation: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.

A client with a history of intimate partner violence has been diagnosed with posttraumatic stress disorder. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurse's best initial action? Make efforts to demonstrate empathy to the client Avoid communicating with the client until the client initiates Arrange for the client to receive cognitive processing therapy Facilitate cognitive restructuring therapy

Make efforts to demonstrate empathy to the client Explanation: Exhibiting empathy often helps to build therapeutic rapport, especially with a client who is reluctant to engage with the nurse. Cognitive behavioral therapy would not be an initial action. It is unrealistic and ineffective for the nurse to avoid communication with the client.

allogenic stem cell transplant

Matched with someone in population from a donor that is genetically similar can be from family or from a donor that is a match with the national bone marrow registry Primary use: DISEASES OF BONE MARROW *Must have HLA (human leukocyte antigen) match* ADVANTAGE: transplanted cells should not be immunologically tolerant of the patient's malignancy and should cause a LETHAL Graft Versus Tumor effect in which the donor cells recognize the malignant cells and attack and kill them

care for patients receiving PPN or TPN

May need to gradually increase/decrease rate Never abruptly stop Monitor glucose q 4-6 hours for at least 1st 24 hours Sterile line change with TPN Tubing/bag changed q 24 hours, use filter per policy Daily labs for electrolytes

Which of the following provided the first comprehensive federal funding program targeted specifically to address the health, education, and welfare of the homeless population? The Affordable Care Act Shelter Plus Care Program McKinney-Vento Homeless Assistance Act Bringing Home America Act

McKinney-Vento Homeless Assistance Act Explanation: The McKinney-Vento Homeless Assistance Act provided the first comprehensive federal funding program targeted specifically to address the health, education, and welfare of the homeless population. The Shelter Plus Program allows for various housing choices and a range of supportive services funded by other sources. The Bringing Home America Act includes housing development, support for living income, rental assistance, job opportunities, civil rights protection for persons without housing, emergency funds to prevent homelessness, and increased access to health care for this population. The Affordable Care Act focuses on preventative care coverage.

treatment of pancreatitis

Meds: Analgesics, antibiotics, H2 receptors make them NPO, monitor shock, if after ERCP, repeat to open, Roux-en-y operation

hyperparathyroidism symptoms

N/V, HTN dysrhythmias, irritability - psychosis, skeletal pain

A client arrives at a clinic to receive treatment for an eye injury. The client states that they were told last night to come to clinical by "good people in a van that gave me a sandwich last night while I was sleeping on the park bench." What conclusion should the nurse make regarding the "good people in a van"? Living skills program Mobile outreach program Transitional housing assistance Spiritual intervention assistance

Mobile outreach program Explanation: Some homeless agencies provide a street or mobile outreach program in which a van travels the streets to unsheltered areas where homeless clients and provide food, warm coffee, hygiene kits, and blankets. Transitional housing consists of a halfway house, a short-stay residence or group home, or a room at a hotel designated for people who are homeless. Living skills programs are usually provided to clients in a day shelter assistance program.

management of chronic gastritis

Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs Pharmacologic therapy (Histamine 2 antagonists, antacids, protein pump inhibitors, prostaglandins, antibiotics)

nursing care of gastritis

Monitor I and O; electrolytes Administer IV fluids as prescribed. Assist the client in identifying foods that are triggers. Provide small, frequent meals and encourage the client to eat slowly. Advise the client to avoid alcohol, caffeine, and foods that can cause gastric irritation. Assist the client in identifying ways to reduce stress. Monitor for indications of gastric bleeding or anemia

A nurse is caring for a client 4 hr postoperative following a kidney biopsy. Which of the following interventions should the nurse take? (Select all that apply).

Monitor for hematuria. Check for flank pain.

A veteran from the Iraqi War is distraught because the spouse is suing the client for divorce and child support. Which intervention should the nurse make a priority for this client's care? Refer to social services. Ask if clergy could be helpful. Discuss possible medication therapy. Monitor for suicide ideation.

Monitor for suicide ideation. Explanation: In a recent year, almost half of the service members who died by suicide had a history of at least one behavioral health disorder, such as substance use disorder, adjustment disorder, or major depression. Stressors associated with suicide included failed/failing intimate partner relationship and legal proceedings. The client going through a divorce and being sued for child support is experiencing a stressor associated with suicide. Social services would not be helpful for this client. There is no evidence that clergy should be involved. Medication therapy would be determined by the health care provider.

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? Monitor the client's heart rate. Monitor the client's physical condition. Monitor the client's toilet patterns. Monitor the client to prevent sepsis.

Monitor the client to prevent sepsis. Explanation: Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.

Treatment of hypothyroidism

Monitor: cardiac status mental status changes respiratory changes. make sure to: Keep warm give stool softeners Cautious use of barbiturate/sedatives due to altered metabolism med: Levothyroxine - synthetic thyroid hormone

A nurse is giving a client barium swallow test. What is the most important assessment a nurse would make to ensure that a client does not retain any barium after a barium swallow?

Monitoring the stool passage and its color. Explanation: Monitoring stool passage and its color will ensure that the client remains barium free following a barium swallow test. The white or clay color of the stool would indicate barium retention. The stool should be placed in a special preservative if the client undergoes a stool analysis. Observing the color and volume of urine will not ensure that the client is barium free because barium is not eliminated through urine but through stool.

:A nurse is caring for a client following an abdominal surgery. The client has a prescription for dressing changes every 4 hr and as needed. Which of the following objects should the nurse use to reduce skin irritation around the incision area?

Montgomery straps Answer Rationale: Montgomery straps are adhesive strips that are applied to the skin on either side of the surgical wound. The strips have holes so the two sides of the dressing can be tied together and re-opened for dressing changes without having to remove the adhesive strips.

Acute Myelogenous Leukemia (AML)

Most common adult leukemia rapidly progressive neoplasm of cells committed to the myeloid line of development

external radiation (EBRT)

Most common form CT, MRI, and PET scans used to pinpoint locations Multiple beams and planes Gamma Ray oldest types Stereotactic body radiation - higher doses for deep tumors; shorter time

A nurse is teaching about adverse effects of anastrozole with a client who has advanced breast cancer and is postmenopausal. Which of the following adverse effects should the nurse recommend the client report to her provider?

Musculoskeletal pain

Which of the following is commonly a warning sign for cancer? Daytime Drowsiness Halitosis Illogical Thinking Night Blindness Nagging Cough Anxiety

Nagging Cough Nagging Coughing Coffee-pot A nagging cough or hoarseness that lasts four weeks or more can indicate lung or throat cancer.

Stage 1 Hepatic Encephalopathy

Normal LOC with lethargy/euphoria; Day/night reversal; writing impaired, Normal EEG

A nurse is teaching a client who is receiving treatments for metastatic colorectal cancer about the adverse effects of bevacizumab. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?

Nose bleeds

N (Node)

Nx- unable to assess N3- increased node involvement

A nurse is caring for a client who is receiving radiation therapy to treat lung cancer. Which of the following actions should the nurse take?

Observe for signs of infection. Answer Rationale: Radiation therapy to sites containing bone marrow (such as the sternum) can lower the WBC count (leukopenia), thus increasing the client's risk for infection.Screening the client for signs of infection is essential at this time.

A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has?

Obstructive jaundice Explanation: Obstructive jaundice is caused by a block in the passage of bile between the liver and intestinal tract. Hemolytic jaundice is caused by excess destruction of red blood cells. Hepatocellular jaundice is caused by liver disease. Cirrhosis of the liver would be an example of hepatocellular jaundice.

A veteran client reports to the clinic after being discharged from service and indicates that there has been an increase in drinking alcohol since retiring. What priority information should the nurse include in the plan of care? Inquire about other social habits that may contribute to alcohol use. Provide educational information related to Alcoholic Anonymous (AA). Encourage the client to become more of a social drinker. Obtain information about the type and frequency of drinking.

Obtain information about the type and frequency of drinking. Explanation: The priority assessment should focus on the type and frequency of drinking in order to determine what the client means by "an increase." The nurse will then be able to clarify alcohol use in more objective terms. Inquiring about other social habits should also be done but it is not the priority at this time. Providing educational information about AA and/or other community organizations may be appropriate, but it is not the priority at this time. Telling the client to become more of a social drinker does not address the critical issue of alcohol use disorder (AUD).

Which of the following is commonly a warning sign for cancer? Angiokeratoma Lacrimation Obvious Change to Warts or Moles Autonomic Symptoms Bitemporal hemianopsia Halitosis

Obvious Change to Warts or Moles Mole with Warts and Moles Following the ABCDEs of melanoma, any change in a wart or mole may indicate skin cancer.

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?

Octreotide Explanation: In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Octreotide (Sandostatin) causes selective splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.

malignant cells -- tissue destruction

Often causes extensive tissue damage as the tumor outgrows its blood supply or encroaches on blood flow to the area; may also produce substances that cause cell damage.

malignant cells -- general effects

Often causes generalized effects, such as anemia, weakness, systemic inflammation, weight loss, and CACS.

a nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). which of the following manifestations should the nurse anticipate? Hypernatremia Oliguria Weight loss Increased thirst

Oliguria The nurse should expect a client who has developed SIADH following a craniotomy to manifest oliguria. The decrease in urine output can be dramatic with output less than 20 mL/hr.

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease?

Pad the side rails on the bed Explanation: Padding the side rails can reduce injury if the client becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint, and this would not be an initial measure to implement. Family and friends generally assist in calming a client.

The nurse is working with clients with digestive tract disorders. Which of the following organs does the nurse realize has effects as an exocrine gland and an endocrine gland?

Pancreas Explanation: The pancreas is both an exocrine gland, one that releases secretions into a duct or channel, and an endocrine gland, one that releases substances directly into the bloodstream. The other organs have a variety of functions but do not have a combination function such as the pancreas.

delivery options for parenteral therapy

Parenteral method: Peripheral o PN (or PPN)- parenteral nutrition via PIV with <10% dextrose Central method: central venous access devices (CVAD) o Percutaneous (nontunneled) catheter o Peripherally inserted central catheter (PICC) o Tunneled central catheter (surgically placed) o Implanted vascular access ports o TPN - total parenteral nutrition via CVL with >10% dextrose

The nurse is assisting the health care provider with a gastric acid stimulation test for a client. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions?

Pentagastrin Explanation: The gastric acid stimulation test usually is performed in conjunction with gastric analysis. Histamine or pentagastrin is administered subcutaneously to stimulate gastric secretions.

Which of the following is a myth related to homeless people with psychiatric disorders? People who are homeless prefer being alone. People who are homeless are from all walks of life. People who are homeless must be creative to secure resources and constantly change life ways to survive. Most people are homeless for a relatively short time.

People who are homeless prefer being alone. Explanation: Peer relations with trusted people are preferred and essential to survival and meeting needs. People who are homeless are from all walks of like. Most people are homeless for a relatively short time. People who are homeless must be creative to secure resources and constantly change life ways to survive.

cushing's complications

Perforated viscera or ulceration - Monitor for GI bleeding Risk for fractures r/t low Calcium Risk for immunosuppression Risk for Adrenal crisis (acute adrenal insufficiency) (Addisonian Crisis)

A nurse is working with a veteran client who reports difficulty sleeping, increasing mood swings, and irritability with a recent onset. Which priority action should the nurse implement? Refer for counseling. Report findings to authorities. Obtain order for bloodwork. Perform a focused screening.

Perform a focused screening. Explanation: Based on the provided client comments, the nurse should perform a focused screening for military sexual trauma (MST) because these behaviors can be representative of survivor reactions. More information is needed before a referral for counseling or a reporting of findings to authorities. Bloodwork may be needed but it is not the priority at this time.

A client undergoing a diagnostic examination for gastrointestinal disorder was given polyethylene glycol/electrolyte solution as a part of the test preparation. Which of the following measures should the nurse take once the solution is administered?

Permit the client to drink only clear liquids. Explanation: After polyethylene glycol/electrolyte solution is administered, the client should have clear liquids because this ensures watery stools, which are necessary for procedures like a barium enema. Allowing the client to ingest a fat-free meal is used in preparation for oral cholecystography. Instructing the client to have low-residue meals is a pretest procedure for barium enema. A client is offered saline gargles after esophagogastroduodenoscopy.

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patients liver? A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand. B) Place the left hand over the abdomen and behind the left side at the 11th rib. C) Place hand under right lower rib cage and press down lightly with the other hand. D) Hold hand 90 degrees to right side of the abdomen and push down firmly.

Place hand under right lower rib cage and press down lightly with the other hand. To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal quadrant.

A nurse is caring for a client who is in a myxedema coma. Which of the following actions should the nurse take?

Place the client on aspiration precautions. Answer Rationale: The nurse should place the client on aspiration precautions because the client can have decreased mental status and is at risk for laryngeal edema and tongue thickening.

Parenteral Nutrition Complications

Pneumothorax, air embolism o Typically related to CVL placement Clotted or displaced catheter o High dextrose makes clotting higher Sepsis o CVL should be sterile Hyperglycemia, hypoglycemia, and/or vitamin deficiencies o Frequent accuchecks (q 4-6) o Possibly need to have D5 nearb

symptoms of diabetes insipidus

Polyuria (4-30L), polydipsia, hypotension, skin tenting, tachycardia

A client is receiving treatment for stage IV ovarian cancer and asks the nurse to discuss her prognosis. The client plans to have aggressive surgical, radiation, and chemotherapy treatments. Which of the following prognoses should the nurse discuss with the client?

Poor

Which is the most common cause of esophageal varices?

Portal hypertension Explanation: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

acute gastritis

rapid onset of symptoms usually caused by dietary indiscretion. Other causes include medications, alcohol, bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause pyloric scarring

A nurse is developing an educational program for veterans who have been diagnosed with opioid use. Which information should the nurse include in the teaching session? Prescription drug use is the most prevalent access problem Opioid use has remained stable over the last 10 years in the veteran population. The current veteran population uses heroin as the drug of choice. Drug use in the older veteran population was more prevalent in the white population.

Prescription drug use is the most prevalent access problem Explanation: Currently, opioid use in the veteran population is associated with prescription drug use due to chronic pain presentations. The older veteran population is more likely to use heroin than opioids. Drug use in the older veteran population was more prevalent in veterans of African descent. Opioid use has increased over recent years in both the veteran and general populations.

Treatment of SIADH

Priority - oral fluid restriction 500 - 1000 mls daily NS for all things, monitor HTN, fluid overload, report AMS Meds: Loop diuretics, hypertonic sodium chloride, vasopressin antagonist (tolvaptan)

Nursing Care of the Patient Undergoing Radiation Therapy

Promote healing, patient comfort, quality of life Assessment oSkin oNutritional status oWell-being vProtecting caregivers

A nurse is evaluating a client's laboratory results. The nurse should recognize that an increase in the client's prostate specific antigen (PSA) laboratory value is indicative of which of the following diagnoses?

Prostatic cancer

medication management of GERD

Proton Pump inhibitors: reduces gastric acid by inhibiting cellular pump - Pantoprazole, omeprazole Antacids: neutralizing excess acid - Aluminum hydroxide, calcium carbonate Histamine 2 receptors antagonists: Reduces secretion of acid - Ranitidine, famotidine - Prokinetics: increase esophageal/stomach motility - Metoclopramide

Symptoms of Crohn's disease

RLQ pain/cramping; anorexia/wt loss Loose stool with mucus/pus Fatty stool Abd distention, tenderness, firmness; high pitched bowel sounds

symptoms of cholecystitis

RUQ pain to R shoulder, n/v after fatty food, jaundice, fatty stool, tenderness to palpation RUQ

internal radiation

Radiation source is placed in the patient—making the patient emit radiation and be a hazard to others for a short time oLocalized treatment §Unsealed isotope—example is radioactive iodine concentrate (thyroid gland) §Sealed—Seeds (prostate Ca) short half life, usually left in place §Implants—constant in hospital several or intermittent in and out of clinic over a period of time

complications for patients with ostomies

stoma ischemia / necrosis / prolapse / retraction intestinal obstruction

malignant cells -- rate of growth

Rate of growth is variable and depends on level of differentiation; the more anaplastic the tumor, the faster its growth.

Following ingestion of carrots or beets, the nurse would expect which alteration in stool color?

Red Explanation: Carrots or beets will tend to change the stool color to red. Black stools are associated with iron, licorice, and charcoal. Senna is associated with yellow stools. A milky white stool is associated with administration of barium.

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?

Reduce fluid accumulation and venous pressure. Explanation: Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective. Promoting optimal neurologic function will not reduce portal hypertension.

management of acute gastritis

Refrain from alcohol and food until symptoms subside If due to strong acid or alkali treatment to neutralize the agent, avoid emetics and lavage due to danger of perforation and damage to esophagus Supportive therapy

A nurse is caring for a client who is 1 day postoperative following a left radical mastectomy. Which of the following behaviors should alert the nurse to the possibility that the client is having difficulty adjusting to the loss of her breast?

Refusing to look at the dressing or surgical incision Answer Rationale: Clients who refuse to look at the surgical incision or surgical dressing are having difficulty adjusting to the loss of a body part or with body disfigurement. This indicates the client is not yet ready to acknowledge the results of the surgery.

Hypercalcemic crisis treatment

Rehydrate UOP 100-150 bisphosphonates in decrease Ca

hyperparathyroidism treatment

Remove parathyroid gland.

A nurse is assessing a client who returned to the unit 4 hr ago after a partial colectomy. Which of the following findings should the nurse attend to first?

Report of severe incisional pain Answer Rationale: The nurse, using the urgent vs. non-urgent approach to care for the client, determines the priority action is to administer pain medication to establish comfort.

A nurse is reading an article about different risk factors for homelessness. The article describes a situation in which a woman with two children leaves her husband because of domestic violence and becomes homeless. The nurse interprets this action as the woman exhibiting which characteristic? Lack of coping skills Resilience Incompetence Depression

Resilience Explanation: Homeless mothers and children have great resilience. Homeless mothers are not necessarily depressed, nor do they have inadequate coping skills. Many of them, having made the decision to free themselves of a noxious relationship, are competent and resilient.

A nurse is caring for a client who is 4 days postoperative following a right radical mastectomy. Which of the following activities should the nurse anticipate being the most difficult for this client to perform with her right hand?

brushing her hair

Most people who are homeless describe themselves as what? Select all that apply. Proud Lazy Resourceful Independent Stupid

Resourceful Independent Proud Explanation: The experience of being homeless for a long time results in a sense of depersonalization and fragmented identity, loss of self-worth and self-efficacy, and a stigma of "being nothing," "a bum," "lazy," and "stupid." However, most people who are homeless describe themselves as resourceful, independent, proud, and survivors.

myexedema coma symptoms

Respiratory failure, hypotension, hypothermia, hyponatremia, hypoglycemia this is a severe form of hypothyroidism!

a nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123. which of the following prescriptions should the nurse anticipate? Maintain an IV of 0.45% sodium chloride. Restrict fluid intake to 1,000 mL per day. Provide a diet containing 2 g of sodium per day. Administer desmopressin acetate 0.2 mg orally.

Restrict fluid intake to 1,000 mL per day. Clients who have SIADH have an increased amount of antidiuretic hormone, which results in excess fluid volume. This excess fluid dilutes the sodium level in the blood, causing dilutional hyponatremia. Oral fluids are restricted in an attempt to restore the fluid balance and the sodium level in the blood. The nurse should offer this client frequent oral care to prevent discomfort and breakdown of the oral mucosa.

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority? Imbalanced nutrition: Less than body requirements Anxiety Risk for infection Risk for injury

Risk for infection Explanation: Risk for infection takes highest priority in clients with severe bone marrow depression because they have a decrease in the number of white blood cells, the cells that fight infection. Making clients aware that they are at risk for injuries can help prevent such injuries as falls. The nurse should institute the facility's falls prevention protocol and supply assistive devices, such as a walker, cane, or wheelchair, when needed. Imbalanced nutrition: Less than body requirements is also of concern but doesn't take priority over preventing infection. Anxiety is likely present in clients with severe bone marrow depression; however, anxiety doesn't take priority over preventing infection.

what drugs can cause SIADH

SSRIs opioids fluoroquinolone antibiotics

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency?

Scurvy Explanation: Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

A nurse is changing the dressing of a client who is 1 week postoperative following abdominal surgery and notes the presence of serosanguineous drainage. The nurse should recognize that this is an indication of which of the following circumstances?

Serosanguineous drainage at this time is a manifestation of possible dehiscence. Answer Rationale: Serosanguineous drainage beyond the fifth postoperative day is a manifestation of possible dehiscence and the provider should be notified.

The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client?

Serum antibodies for H. pylori Explanation: Helicobacter pylori, a bacterium, is believed to be responsible for the majority of peptic ulcers. Blood tests are used to determine whether there are antibodies to H. pylori in the blood. A complete blood count with differential can indicate bleeding and infection associated with a bleeding ulcer. A sigmoidoscopy assesses the lower gastrointestinal tract. Gastric analysis is more common in analyzing gastric fluid in determining problems with the secretory activity of the gastric mucosa.

The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client? Serum antibodies for H. pylori A complete blood count including differential Gastric analysis A sigmoidoscopy

Serum antibodies for H. pylori Explanation: Helicobacter pylori, a bacterium, is believed to be responsible for the majority of peptic ulcers. Blood tests are used to determine whether there are antibodies to H. pylori in the blood. A complete blood count with differential can indicate bleeding and infection associated with a bleeding ulcer. A sigmoidoscopy assesses the lower gastrointestinal tract. Gastric analysis is more common in analyzing gastric fluid in determining problems with the secretory activity of the gastric mucosa.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Blood pressure of 120/64 to 130/72 mm Hg Serum potassium level of 2.6 mEq/L Sodium level of 142 mEq/L Urine output of 400 ml in 8 hours

Serum potassium level of 2.6 mEq/L Explanation: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

A nurse is caring for an older adult client who has a WBC count of 2,000/mm3 after three rounds of chemotherapy. Which of the following actions should the nurse take?

Serve cooked fruit with meals. Answer Rationale: The nurse should serve cooked fruits with meals to prevent possible bacterial contamination from raw fruit.

A nurse if caring for an older adult client who has a WBC of 2,000/mm^3 after three rounds of chemotherapy. Which of the following actions should the nurse take?

Serve cooked fruits with meals

a nurse is assessing a client and discovers the infusion pump with the client's total parenteral nutrition (TPN) solution is not infusing. the nurse should monitor the client for which of the following conditions? Excessive thirst and urination Shakiness and diaphoresis Fever and chills Hypertension and crackles

Shakiness and diaphoresis When a sudden interruption in the infusion of TPN occurs, the client is at risk for hypoglycemia. Shakiness and diaphoresis are manifestations of hypoglycemia.

peptic ulcer: perforation or penetration nursing actions

Signs include severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board-like abdomen, and symptoms of shock or impending shock Patient requires immediate surgery

A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client?

Spironolactone Explanation: The use of diuretic agents along with sodium restriction is successful in 90% of clients with ascites. Spironolactone, an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. When used with other diuretic agents, spironolactone helps prevent potassium loss. Oral diuretic agents such as furosemide may be added but should be used cautiously because long-term use may induce severe hyponatremia (sodium depletion). Acetazolamide and ammonium chloride are contraindicated because of the possibility of precipitating hepatic encephalopathy and coma.

A nurse is developing a plan of care for a client who is 12 hr postoperative following colon resection. Which of the following interventions should the nurse include in the plan to reduce respiratory complications?

Splint the incision to support coughing every 2 hr. Answer Rationale: Breathing exercises include deep or diaphragmatic breathing to enlarge the chest cavity and expand the lungs. Coughing and splinting may be performed also with deep breathing every 1 to 2 hr after surgery. The purposes of coughing are to expel secretions, keep the lungs clear, allow full aeration, and prevent pneumonia and atelectasis.

A nurse is caring for a client who is 1 day postoperative following a mastectomy. Which of the following exercises should the nurse assist the client to perform on the affected side? Select all that apply.

Squeezing a rolled wash cloth Flexing and extending her hand Flexing and extending her elbow

A nurse is caring for a client who is 1 day postoperative following a mastectomy. Which of the following exercises should the nurse assist the client to perform on the affected side? (Select all that apply.)

Squeezing a rolled washcloth Flexing and extending her hand Flexing and extending her elbow

tumor staging and grading

Staging: determines size of tumor, existence of metastasis TNM T: extent of primary tumor N: lymph node involvement M: extent of metastasis Grading: classification of tumor cells - define tissue of origin - differentation from original function / histology - grade I-IV

The instructor has just finished teaching a group of students about the various organs of the upper gastrointestinal tract and possible disorders. The instructor determines that the teaching was successful when the students identify which structure as possibly being affected?

Stomach Explanation: The upper gastrointestinal (GI) tract begins at the mouth and ends at the jejunum. Therefore, the stomach would be a component of the upper GI tract. The lower GI tract begins at the ileum and ends at the anus. The liver is considered an accessory structure.

hiatal hernias

Stomach moves through hole in diaphragm some are asymptomatic some have heartburn/regurgitation

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms? Stomatitis Neutropenia Nadir Extravasation

Stomatitis Explanation: The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to 10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.

A nurse is administering a peripheral chemotherapeutic agent. What nursing actions are used for extravasation of a chemotherapeutic agent? Select all that apply. Administer an antidote, if indicated Schedule the client for implanted device Apply warm compresses to the irritated site to encourage healing Aspirate any residual drug from the IV line Stop the medication infusion at the first sign of extravasation

Stop the medication infusion at the first sign of extravasation Aspirate any residual drug from the IV line Administer an antidote, if indicated Explanation: All of the answers except application of a warm compress are appropriate nursing actions. The application of warmth would be contraindicated because it would cause vasodilation, which would increase the absorption of irritant into the local tissues. Short term chemotherapy can be done with peripheral catheters so the client may not need an implanted device.

A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately Administers diphenhydramine Gives prednisolone IV Places the client on oxygen by nasal cannula Stops the chemotherapeutic infusion

Stops the chemotherapeutic infusion Explanation: The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.

What organization recommends a five-stage process in rehabilitation for persons homeless with a mental illness? Substance Abuse and Mental Health Service Administration (SAMSHA) Centers for Medicaid and Medicare Services (CMS) Social Security Administration (SSA) State government offices (SGO)

Substance Abuse and Mental Health Service Administration (SAMSHA) Explanation: Substance Abuse and Mental Health Services Administration (SAMSHA) recognize that housing is critical to recovery from mental and substance abuse disorders and promotes safe, affordable, and permanent support in the community with access to benefits and services for individuals, families, and communities. SAMSHA recommends a five-stage process in homeless rehabilitation for persons who are homeless with a mental illness. CMS provides health insurance coverage for Medicare and Medicaid clients. The Social Security Administration is an independent agency of the U.S. federal government that administers Social Security, a social insurance program consisting of retirement, disability, and survivors' benefits. State government offices may offer financial support for the SAMSHA program.

symptoms of pancreatitis

Sudden onset epigastric pain radiating back/left flank/shoulder, n/v, bruising flank, fruity breath, tetany

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks? Pool and water safety Hand washing and infection prevention Breast and testicular self-exams Sun safety and use of sunscreen

Sun safety and use of sunscreen Explanation: Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.

The nurse is preparing to examine the abdomen of a client who reports a change in bowel pattern. The nurse would place the client in which position?

Supine with knees flexed Explanation: When examining the abdomen, the client lies supine with knees flexed. This position assists in relaxing the abdominal muscles. The lithotomy position commonly is used for a female pelvic examination and to examine the rectum. The knee-chest position can be used for a variety of examinations, most commonly the anus and rectum. The left Sim's lateral position may be used to assess the rectum or vagina and to administer an enema.

peptic ulcer: pyloric obstruction nursing actions

Symptoms include nausea and vomiting, constipation, epigastric fullness, anorexia, and (later) weight loss insert NG tube to decompress the stomach, provide IV fluids and electrolytes. Balloon dilation or surgery may be required

a nurse is teaching a group of middle adult clients about early detection of colorectal cancer. the nurse should include the American Cancer Society recommendation that men and women beginning at age 50 who are at average risk should have a fecal occult blood test (FOBT) and a colonoscopy at which of the following intervals? Five years Ten years One year Two years

Ten years Ten years is the recommended interval for colonoscopy screening for clients who have an average risk.

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? The client begins to shiver. The client states he is nauseous. The I.V. site is red and swollen. The laboratory reports a white blood cell (WBC) count of 1,000/mm3.

The I.V. site is red and swollen. Explanation: A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time.

A college student who was the victim of an attempted sexual assault has sought care due to anxiety that is affecting every aspect of the client's life. Which characteristic of the client's situation and the client's anxiety would suggest a diagnosis of posttraumatic stress disorder (PTSD) rather than acute stress disorder? The attack took place several months ago, and the client's anxiety has been continuous. Concerns for the client's safety have caused the client to change daily routines. The attack was an isolated, rather than ongoing, event. Complementary and alternative therapies have failed to resolve the client's anxiety.

The attack took place several months ago, and the client's anxiety has been continuous. Explanation: Acute stress disorder is differentiated from PTSD in that symptoms occur during or immediately after the trauma and last for at least 2 days. If symptoms do not resolve within 4 weeks after the conclusion of the event, the diagnosis is changed to PTSD. The two diagnoses are not differentiated on the basis of response to alternative therapies, the presence of a one-time causative event, or changes in the client's routine in response to anxiety.

What action by a 6-year-old child would most strongly suggest a diagnosis of disinhibited social engagement disorder? The child has several friends that are much older or much younger than the child The child claims to have dozens of friends but no "best friend" The child gives adults enthusiastic hugs immediately after meeting them The child tells the nurse "secrets" during their initial meetings

The child gives adults enthusiastic hugs immediately after meeting them Explanation: Disinhibited social engagement disorder is characterized by being overly familiar with strangers. It is not associated with having a large number of diverse friends. The child's willingness to confide in the nurse is not necessarily inappropriate or problematic.

A nurse is reviewing the medication administration records of four clients who have a prescription for morphine PRN. Which of the following findings should the nurse identify as a contraindication to this medication?

The client has a paralytic ileus. Answer Rationale: Morphine is contraindicated in clients who have a paralytic ileus because morphine suppresses the propulsive contractions of the intestinal tract and inhibits secretion of fluids into the intestinal tract.

A nurse is reviewing the medical record of a client who has acute leukemia. Diagnostic Results Month One: WBC count 15,500/mm3 (5,000 to 10,000/mm3) RBC count 4.3 million/mm3 (4.2 to 5.4 million/mm3) Hemoglobin 15 g/dL (12 to 16 g/dL) Hematocrit 45% (37% to 47%) Platelet count 160,000/mm3 (150,000 to 400,000/mm3) PT 11.5 seconds (11 to 12.5 seconds) INR 1 second (0.8 to 1.1 seconds) PTT 65 seconds (60 to 70 seconds) Sodium 139 mEq/L (136 to 145 mEq/L) Potassium 4.2 mEq/L (3.5 to 5 mEq/L) Glucose 100 mg/dL (74 to 106 mg/dL) BUN 16 mg/dL (10 to 20 mg/dL) Creatinine 0.8 mg/dL (0.5 to 1 mg/dL) Calcium 9.5 mg/dL (9 to 10.5 mg/dL) Vitamin D 65 ng/dL (25 to 80 ng/dL) Month Three: WBC count 15,500/mm3 (5,000 to 10,000/mm3) RBC count 4.0 million/mm3 (4.2 to 5.4 million/mm3) Hemoglobin 11 g/dL (12 to 16 g/dL) Hematocrit 33% (37% to 47%) Platelet count 100,000/mm3 (150,000 to 400,000/mm3) PT 13.5 seconds (11 to 12.5 seconds) INR 2.2 seconds (0.8 to 1.1 seconds) PTT 85 seconds (60 to 70 seconds) Sodium 137 mEq/L (136 to 145 mEq/L) Potassium 4.5 mEq/L (3.5 to 5 mEq/L) Glucose 98 mg/dL (74 to 106 mg/dL) BUN 15 mg/dL (10 to 20 mg/dL) Creatinine 0.8 mg/dL (0.5 to 1 mg/dL) Calcium 9.5 mg/dL (9 to 10.5 mg/dL) Vitamin D 65 ng/dL (25 to 80 ng/dL) Drag words from the choices below to fill in each blank in the following sentence. The client is at risk for developing _____________ and ________________. word choices: infection fracture bleeding dysrhythmia

The client is at risk for developing BLEEDING and INFECTION. Bleeding and infection are correct. Bleeding is one of the major causes of death for clients who have acute leukemia. The nurse should note that the client's platelet count has decreased, and the PT, PTT, and INR levels have all increased, which places the client at a high risk for bleeding. Infection is also one of the major causes of death for clients who have acute leukemia. The WBC count can be low, normal, or high in leukemia, but the cells are small and nonfunctioning. The inability of the client's WBCs to mount an appropriate protection against invading micro-organisms places the client at a high risk for infection. Fracture and dysrhythmia are incorrect. While clients who have acute leukemia can experience joint and bone pain, fracture is not a common risk. The nurse should note that the client's calcium and vitamin D levels are within the expected reference ranges. While clients who have acute leukemia can experience alterations in electrolytes that can lead to dysrhythmias, the nurse should note that the client's potassium, sodium, and calcium levels are all within the expected reference ranges.

What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing dissociation? The client experiences awakenings during the night and is unable to fall asleep again The client is often "staring into space" and has no idea how much time has passed The client states that the client's mood is "alright" when appearing to be in some distress The client states that usual coping mechanisms are ineffective

The client is often "staring into space" and has no idea how much time has passed Explanation: "Spacing out" is an example of dissociation (depersonalization). It is not uncommon for the client with PTSD to experience failure of coping skills, sleep disturbances, and reluctance to acknowledge moods, but these are not evidences of dissociation.

During an physical assessment of a homeless client, the client refuses to answer a few of the nurse's questions and states that they do not want the nurse to touch them. What may be the reason for this behavior? The client is being stubborn. The client is delusional and has paranoia. The client may be embarrassed about their physical appearance. The client is feeling the nurse cannot provide adequate care.

The client may be embarrassed about their physical appearance. Explanation: During the physical health assessment, the nurse needs to provide privacy and avoid being in a hurry. The client may be embarrassed about their physical appearance or hygiene. The nurse should explain their concern about the client's health status and provide a thorough assessment. The client does not have delusions or paranoia. The client does not feel the nurse cannot provide adequate care.

A male combat veteran with a diagnosis of post-traumatic stress disorder has been prescribed prazosin. What outcome would most clearly indicate the effectiveness of this treatment? The client states that he is more willing to discuss his trauma. The client's family describes him as "more relaxed". The client reports fewer and less intense nightmares. The client reports greater energy for accomplishing daily tasks.

The client reports fewer and less intense nightmares. Explanation: Prazosin is used in the treatment of PTSD to improve sleep and relieve nightmares. Outcomes such as increased energy, less hyperarousal and emotional openness would be indirect outcomes of the effects on sleep and nightmares.

The nurse is dialoguing with a client who has been referred after witnessing a workplace accident several weeks ago that resulted in a coworker's death. What assessment finding would support a diagnosis of posttraumatic stress disorder (PTSD)? The client states that the client is often "awake for hours and hours each night." The client's work performance has suffered after the event. The client avoided the coworker's family in the days after the event. The client had to take several sick days in the days after the event.

The client states that the client is often "awake for hours and hours each night." Explanation: Sleep disturbances are key diagnostic characteristics of PTSD. Each of the other assessment findings should be addressed, but none is a diagnostic criterion for PTSD.

A nurse is assessing a client's veteran identity. Which findings best support a strong veteran identity? The client does not talk much about military service. The client expresses ambivalence about time spent in the service. The client indicates veteran status on a history form. The client wears a military service hat on a daily basis.

The client wears a military service hat on a daily basis. Explanation: Research on veterans' identity concept focuses on three areas: the importance of reflection of being a veteran, thinking of oneself as a veteran, and the importance of others knowing about one's veteran's status. The client wearing a military service hat on a daily basis indicates all three areas. Expressing ambivalence about military service does not align with a strong veteran identity. Not talking much about military service or indicating veteran status on a history form does not align with a strong veteran identity.

Which of the following represents a realistic goal when planning care for a homeless client with mental illness? The client will maintain a home in a subsidized housing facility. The client will gain insight into the causes of his mental illness. The client will resume previous level of functioning. The client will use available community resources.

The client will use available community resources. Explanation: Treatment goals for a homeless mentally ill person may include the following: The client will satisfy physical needs and remain safe; the client will understand the symptoms of his or her mental illness; the client will build a therapeutic alliance with providers; and the client will identify and use psychosocial supports.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?

The client's hepatic function is decreasing. Explanation: The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

The nurse is assessing a client who was sexually assaulted several months ago and who has subsequently developed posttraumatic stress disorder (PTSD). The nurse observes that the client's nonverbals are closed and the client is reluctant to engage with the nurse. How should the nurse best interpret this client's behavior? The client has likely responded poorly to prior treatments The client has likely had a series of negative interactions with health providers The client's trauma likely has an impact on the client's ability to trust The client's PTSD is affecting the client's cognition and information processing

The client's trauma likely has an impact on the client's ability to trust Explanation: Persons whose trauma resulted from sexual assault are likely to be reluctant to trust. It is possible that the client has had negative encounters with health care providers, but issues related to trust are more likely, given the nature of the client's trauma. Cognitive deficits are less likely, and mistrust is not necessarily indicative that treatment is ineffective.

A client with post-traumatic stress disorder (PTSD) has just been prescribed sertraline by her primary care provider. What topic should the nurse include during health education? The importance of avoiding aged cheese, wine, beer and shellfish The importance of avoiding alcohol use during treatment The need to avoid grapefruit juice or fresh grapefruit The need to monitor blood pressure during treatment

The importance of avoiding alcohol use during treatment Explanation: Alcohol intake should be eliminated during treatment with a sustained serotonin reuptake inhibitor. There is no need to avoid tyramine-containing foods or grapefruit. SSRIs do not normally affect blood pressure significantly.

A nurse is reviewing the concept of veteran identity. Which finding would best support a strong association with this concept? The individual asks that all information provided be kept confidential. The individual prefers to not talk about past service. The individual participates in veteran community groups. The individual is focused on present tasks.

The individual participates in veteran community groups. Explanation: The concept of veteran identity can be determined by the responses to three questions graded on a 0 to 4 scale that examine the importance of being a veteran by self-reflection, thinking of one being a veteran, and the importance of others being aware of the veteran status. The individual who participates in veteran community groups is displaying agreement with all responses. Preferring not to talk about past service, focusing on present tasks, and keeping information confidential does not identify with the concept of veteran identity.

A client who is homeless and diagnosed with bipolar disorder presents to the clinic for a follow-up visit and a nurse begins the assessment. Which observation by the nurse manager warrants immediate intervention? The nurse is focused on documentation and avoids eye contact with the client. The nurse focuses on the client's answers before asking additional questions. The nurse asks additional questions to clarify the client's responses. The nurse addresses the client by their name.

The nurse is focused on documentation and avoids eye contact with the client. Explanation: Each client (whether homeless or not) should be afforded respect and courtesy. Myths associated with people experiencing psychiatric disorders include but are not limited to that they choose to be homeless and/or they aren't smart enough to succeed. The nurse, by focusing on the health record and avoiding eye contact with the client, is not being respectful. It is important for health care professionals to provide equitable care to all populations.

Why would the psychiatric nurse need to be cautious about formulating nursing diagnoses quickly for a homeless person? The nurse needs to become familiar with the person's street life due to misinterpretation of unusual behaviors. The nurse needs to spend more time in the homeless person's environment, even being on the street with the person, so he or she can more easily make judgments about the person's values and belief systems. The homeless person is likely to be untrustworthy and may not provide accurate data. The homeless person is often psychotic and cannot relate to the nurse.

The nurse needs to become familiar with the person's street life due to misinterpretation of unusual behaviors. Explanation: Nursing diagnoses must be formed cautiously after becoming familiar with the norms and necessities of street life because some unusual behaviors may be adaptive mechanisms. For example, clients may wear excessive clothing to prevent theft or to keep others from disturbing them. Likewise, they may consciously exhibit bizarre behaviors to keep others away.

A client has developed posttraumatic stress disorder (PTSD) after a violent sexual assault committed by a close family member. When planning this client's care, the nurse should follow what guideline? The nurse should encourage the client to use progressive relaxation techniques rather than prescribed medications The nurse should avoid touching the client during interactions unless necessary The nurse should ensure that a colleague is present when the client is assessed The nurse should encourage limiting contact with friends and family until the client's mood improves

The nurse should avoid touching the client during interactions unless necessary Explanation: The nurse should use touch with great caution when working with a client who has experienced a sexual assault. There is no clear need for two caregivers to be present during an assessment. If medications have been prescribed, the nurse should never encourage the client to not take them. The client's support network should be accessed as much as possible.

A nurse is conducting a health history of a homeless client. The client has a history of schizophrenia. The nurse notices that the client is not answering some of the questions appropiately, does not smile or maintain eye contact, and is evasive in the responses. What is the nurse's best assessment of this behavior? These responses warrant additional information related to medication adherence. The actions require immediate hospitalization. The responses are common to this client. The nurse should ask another nurse to assist.

The responses are common to this client. Explanation: Symptoms of schizophrenia may be difficult to differentiate from emotional responses to the stressors of a homeless lifestyle. Blunted affect, lack of communication, loose associations, ambivalence, isolation, and uncertainty may be the result of life on the streets and living in various places. Such symptoms or behaviors may be part of the homeless experience and reflect healthy coping mechanisms and creative survival techniques rather than pathology. Calling another nurse or a provider is not necessary.

Which nursing instruction is correct to provide the client following a barium enema?

The stools may be a white or clay colored. Explanation: It is important to instruct the client that it is normal to have a white- or clay-colored stool following the barium enema. The client should report the color of the stool to the nurse. A progression of clay colored stools to brown-colored stools should be noted. The client is prescribed a low-residue diet before the procedure. An increased fluid intake is offered to eliminate the barium from the bowel. The client is encouraged to move the bowel independently.

dissociative fugue

The sudden loss of memory for one's personal history, accompanied by an abrupt departure from home and the assumption of a new identity may last months of years

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. The second and third drugs increase the effectiveness of the first drug. The three drugs can be given at lower doses. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.

The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Explanation: Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.

A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply. The incubation period for this virus is up to 4 months. There is a 70% chance that jaundice will occur. Transmission of the virus is possible with oral-anal contact during sex. Typically there is a spontaneous recovery. There is a 50

There is a 70% chance that jaundice will occur. Transmission of the virus is possible with oral-anal contact during sex. Typically there is a spontaneous recovery. Explanation: The incubation period for hepatitis A is 15 to 50 days, with an average of 28 days. The risk of cirrhosis occurs with hepatitis B.

Which of the following is commonly a warning sign for cancer? Contralateral Anesthesia Anal Fissure Arrhythmias Aseptic Meningitis Lacrimation Thickening or Lump in the Breast or Elsewhere

Thickening or Lump in the Breast or Elsewhere Woman with Thick Breast and Lumps Any thickening of tissue or lump can be a sign of cancer. If located on the breast (breast cancer); If on the testicle (testicular cancer).

A nurse is caring for a client who has chemotherapy- induced peripheral neuropathy. The nurse should expect the client to report having experienced which of the following symptoms?

Tingling feeling in the extremities Answer Rationale: Peripheral neuropathy is a neurological disorder resulting from damage to the peripheral nerves. It may be caused by diseases of the nerves, systemic illnesses, or it may be a side-effect from chemotherapy. If a sensory nerve is damaged, the client is likely to experience pain, numbness, tingling, burning, or a loss of feeling in the extremities.

A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect?

Tingling of the extremities Answer Rationale: A serum calcium level of 7.6 mg/dL is below the expected reference range, indicating hypocalcemia. A client who undergoes a total thyroidectomy is at risk for parathyroid injury which can lead to hypocalcemia. The nurse should monitor the client for reports of tingling and numbness of the extremities and around the Mouth, muscle tremors, cramps and cardiac dysrhythmias.

A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching?

Tinnitus

A client with metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy? To prevent metastasis Fatigue Stomatitis Angiogenesis

To prevent metastasis Explanation: Chemotherapy treats systemic and metastatic cancer. It can also be used to reduce tumor size preoperatively, or to destroy any remaining tumor cells postoperatively. Angiogenesis is the growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth. Fatigue and stomatitis are side effects of radiation and chemotherapy.

A nurse is providing discharge instructions to a client who was admitted for a respiratory illness.The nurse is teaching about infection prevention precautions. The nurse asks the client about where the client lives. The client describes the place where they live with others, share housekeeping tasks, and attend group meetings every day. What is the kind of housing the client is describing? Mobile outreach program Section 8 housing Transitional housing Unsheltered living arrangement

Transitional housing Explanation: The client is describing transitional housing. Transitional housing can consist of a halfway house, a short-stay residence or group home, or a room at a hotel designated for people who are homeless. Transitional housing is a center where residents share housekeeping tasks, obtain psychiatric stabilization, and attend group meetings, social skills and classes. Unsheltered living arrangement is where clients who are homeless live in places not designated for sleeping like a car or bus/train station. Mobile outreach program is a van that travels the streets to areas where homeless are found outdoors and provides food, warm coffee, hygiene kits, and blankets. Section 8 housing is federally subsidized housing units supervised or operated by the state or city for which tenant is responsible for paying one third of the monthly income toward rent.

liver transplant

Transplanted portion with regenerate and grow to size needed. Must meet criteria. - No Cardiac/respiratory/metastatic liver cancer or substance abuse.

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? Tumor pressure against normal tissues Emission of abnormal proteins Cells colonizing to distant body parts Random, rapid growth of the tumor

Tumor pressure against normal tissues Explanation: Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.

T (tumor)

Tx- unable to assess T4- larger number signifies increasing size

acute graft rejection post liver transplant

Typical 4-10 post transplant. Tachycardia, UR flank pain, jaundice, liver failure labs. Early id key to prevent total organ loss. Immunosuppressants, monitor labs. Teach about meds, and sx of rejection

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses?

Ultrasonography Explanation: A ultrasonography will show the size of the abdominal organs and the presence of masses. Magnetic resonance imaging is used to detect hepatic neoplasms. An angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An electroencephalogram is used to detect abnormalities that occur with hepatic coma.

Hyperglycemic Hyperosmolar Syndrome (HHS)

Uncontrolled hyperglycemia, hyperosmolarity leading to dehydration, no ketones/ketosis

Diabetic Ketoacidosis (DKA)

Uncontrolled hyperglycemia, metabolic acidosis, ketones in blood / urine

causes of DKA

Undiagnosed / untreated DM1, missed/reduced insulin doses, illness

When teaching about vulnerable populations, the nursing instructor lists the homeless as an example. What are some risk factors known to lead to homelessness? Select all that apply. Mental illness Lack of skills Unemployment Multiple children in family Part-time work Substance abuse

Unemployment Lack of skills Mental illness Substance abuse Explanation: Many factors can contribute to homelessness including unemployment, lack of skills, mental illness, substance abuse, and domestic violence.

A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long should the nurse withhold food and fluids?

Until the gag reflex returns Explanation: After the endoscopic examination, fluids are not given until the patient's gag reflex returns.

Which of the following is commonly a warning sign for cancer? Unusual Bleeding or Discharge Angioedema Hyperirritability Bitemporal hemianopsia Daytime Drowsiness Bronchoconstriction

Unusual Bleeding or Discharge Guy with Unusual Bleeding or Discharge Unusual bleeding or discharge from the bladder, vagina, or rectum may include colorectal, cervical, or prostate cancer.

A client is receiving radiation therapy and asks the nurse about oral hygiene. What teaching specific to the client's situation should the nurse include? Floss before going to bed. Treat cavities immediately. Use a soft toothbrush and allow it to air dry before storing. Gargle after each meal.

Use a soft toothbrush and allow it to air dry before storing. Explanation: The nurse advises the client undergoing radiation therapy to use a soft toothbrush to avoid gum lacerations and allow the toothbrush to air dry before storing. Gargling after each meal, flossing before going to bed, and treating cavities immediately are general oral hygiene instructions.

A charge nurse is teaching a group of health care workers about hand hygiene to prevent infection. Which of the following information should the charge nurse include"

Use chlorhexidine to wash hands if the client is immunosuppressed.

A nurse is getting ready to perform a physical assessment on a client who is homeless who presented to the clinic. Which nursing action represents the best approach? Use observation first and engage the client in conversation prior to performing any tactile assessments. Inspect, palpate, and percuss as needed to elicit physical examination information. Ask specific questions to obtain information related to the physical exam. Have the client remove all of their clothes, provide an examination gown, and leave the room to provide privacy.

Use observation first and engage the client in conversation prior to performing any tactile assessments. Explanation: The physical examination of an individual who is homeless should incorporate the elements of look, touch, palpate, and auscultate, with the nurse being mindful of not being intrusive, which could result in the client feeling apprehensive and/or leaving the exam room environment. Therefore, it is important to first use observation and engage the client in conversation prior to performing any tactile assessments. Having the client remove all of their clothes may lead to feelings of apprehension. Asking specific questions may also lead to apprehension, avoid unnecessary directness or probing.

A nurse is caring for a client who is 1 day postoperative following a transurethral resection of the prostate (TURP) and has a continuous bladder irrigation in place. Which of the following actions should the nurse take? (Select all that apply.)

Use sterile technique when preparing the irrigation solution. Ensure the drainage tubing is patent and without obstruction. Notify the surgeon if the urine is bright red in appearance or has large clots

benign cells -- general effects

Usually a localized phenomenon that does not cause generalized effects unless its location interferes with vital functions.

Which of the following is the most effective strategy to prevent hepatitis B infection?

Vaccine Explanation: The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?

Vasopressin Explanation: Vasopressin may be the initial therapy for esophageal varices because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

treatment of DI

Vasopressin (desmopressin) - intranasally, orally Monitor VS, electrolytes, confusion, sx water intoxication

A nurse is caring for a client who is 1-day postoperative following a left lower lobectomy and has a chest tube in place. When assessing the client's three-chamber drainage system, the nurse notes that there is no bubbling in the suction control chamber. Which of the following actions should the nurse take?

Verify that the suction regulator is on and check the tubing for leaks. Answer Rationale: A lack of bubbling may indicate that either the suction regulator is turned off or that there is a leak in the tubing

A nurse is caring for a client who is 1 day postoperative following a thyroidectomy and reports severe muscle spasms of the lower extremities. Which of the following actions should the nurse take?

Verify the most recent calcium level. Answer Rationale: A client who has had a thyroidectomy is at risk of hypocalcemia due to the possible disruption of the parathyroid gland during surgery. The parathyroid glands are four small glands located inside the thyroid gland that are responsible for calcium regulation. If they are damaged during a thyroidectomy, there is a risk of hypocalcemia. Low calcium levels can be manifested as numbness and tingling of the fingers and around the mouth, muscle spasms (particularly of the hands and feet), and hyperactive reflexes. If a client develops any of these manifestations following a thyroidectomy, the nurse should check the client's latest calcium level.The expected reference range for calcium is 8.5 to 10.5 mg/dL. If the calcium level is low, the provider should be notified, and oral or intravenous calcium replacement should be administered.

A nurse is preparing a presentation for a local community group about homelessness. Which information would the nurse most likely identify as a general cause of homelessness? Select all that apply. Adequate coping skills Prison release Employment Domestic violence Veteran status

Veteran status Domestic violence Prison release Explanation: General causes of homelessness include veteran status, domestic violence, prison release, and poverty. Having adequate coping skills and employment are not general causes of homelessness.

The nurse is preparing a presentation for military veterans who have an average age of 71. For which conflict should the nurse incorporate specific health issue information? peacetime World War II Vietnam era post-9/11 group

Vietnam era Explanation: A military veteran refers to a person who served in the armed forces. The Vietnam Era lasted from 1964 to 1975 with the median age of veterans being about 71 years. The peacetime era is between the end of the Vietnam War to the post-9/11 era. World War II veterans are the oldest group in the US and have a median age of about 93 years. The post-9/11 group served in the military after September 2001 and has a median age of about 37 years.

A nurse is contributing to the interdisciplinary care plan for a client who has been diagnosed with PTSD. Which should be included in the care plan? Frequent assessment for delusional thinking or hallucinations Administration of monoamine oxidase inhibitors (MAOIs) as prescribed Education to the client about appropriate social interactions Vigilant monitoring for potential indications of self-harm

Vigilant monitoring for potential indications of self-harm Explanation: The risk for suicide or other forms of self-harm is high in clients with PTSD. MAOIs are not used to treat the disorder, and delusions and hallucinations rarely occur. Social isolation is common among patients with PTSD; inappropriate social interactions, however, are less common.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery?

Vitamin K Explanation: Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

thyroidectomy complications: nerve damage

Vocal cord paralysis Intervention: Have patient speak q 2 hours

A nurse is reviewing the CBC findings for a female client who is receiving combination chemotherapy for breast cancer. Which of the following findings should the nurse report to the provider?

WBC 2,300?mm^3

A nurse is reviewing the CBC findings for a female client who is receiving combination chemotherapy for breast cancer. Which of the following findings should the nurse report to the provider?

WBC 2300/mm3 Answer Rationale: This WBC finding is below the expected reference range. Chemotherapy treatment can cause leukopenia; the nurse should report this finding to the provider and implement precautions to protect the client from infection.

Which condition indicates an overdose of lactulose?

Watery diarrhea Explanation: The client receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.

symptoms of dumping syndrome

Weakness, diaphoresis, palpitations, dizziness, diarrhea

Which of the following would be inconsistent as a common side effect of chemotherapy? Weight gain Fatigue Myelosuppression Alopecia

Weight gain Explanation: Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.

Benign cells -- characteristics

Well-differentiated cells resemble normal cells of the tissue from which the tumor originated.

a nurse is caring for a client who has acute pancreatitis. after treating the client's pain, which of the following should the nurse address as the priority intervention? Auscultate the client's lungs. Assist the client to a side-lying position. Provide oral hygiene. Withhold oral fluids and food.

Withhold oral fluids and food. To rest the pancreas and reduce secretion of pancreatic enzymes, NPO status must be initiated and maintained during the acute phase of pancreatitis. This is the priority intervention to address after the client's pain has been treated.

A nurse is assessing a client who is 48 hr postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?

Yellow-green drainage on the surgical incision Answer Rationale: Thick yellow-green drainage is indicative of an infection and should be reported immediately.

A client who is a veteran of a foreign war reports having pain for more than "half a year." Which body area should the nurse anticipate the client is experiencing discomfort? head back neck jaw

back Explanation: The prevalence of chronic pain, or pain lasting longer than 3-6 months, occurs more frequently in veterans than non-veterans. Chronic back pain in veterans is the most frequently reported type of pain followed by jaw pain, severe headaches or migraine, and neck pain.

ACTH stimulation test

blood analysis for cortisol levels after administration of synthetic adrenocorticotropic hormone (ACTH)

eosinophilic esophagitis

a chronic immune system disease in which a type of white blood cell called an eosinophil builds up in the esophagus, usually as the result of an allergy to certain foods, causes GERD

post-traumatic stress disorder (PTSD)

a disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for 1 month or more after a traumatic experience

Acute Stress Disorder (ASD)

a disorder resulting from exposure to a major stressor, with symptoms of: anxiety, dissociation, recurring nightmares, sleep disturbances, problems in concentration, and moments in which people seem to "relive" the event in dreams and flashbacks lasts 3 days - 1 month

A client has been diagnosed with posttraumatic stress disorder (PTSD) after witnessing an explosion at the client's industrial worksite. The client will soon begin exposure therapy, so the nurse should prepare the client for: a visit with the therapist to the place where the explosion occurred. a visit to a support group created for victims of the tragedy. a critical examination of the ways the client's PTSD has affected the client's life. a family meeting where each member will describe the effects of the client's PTSD.

a visit with the therapist to the place where the explosion occurred. Explanation: Exposure therapy may involve a visit to the place where a traumatic event occurred. Reflection, family meetings, and support groups may be components of the client's broader treatment plan, but they are not exposure therapy.

acute gastritis symptoms

abdominal discomfort, headache, lassitude (lethargy), nausea, vomiting, hiccupping

hyperthyroidism/ grave's disease

abnormally high secretion of thyroid hormones

The nurse completes an assessment of a client who was recently discharged from active duty. For which reason will the nurse implement actions to prevent the client from suicide? scheduled for work interviews abused as a child social use of marijuana spouse working a part-time job

abused as a child Explanation: Childhood abuse is associated with suicide behavior in adulthood. Combat-exposed veterans with a history of childhood sexual abuse are nearly three time more likely to contemplate suicide compared to those without a history of abuse. Childhood sexual abuse is a stronger predictor of suicide attempts than either childhood physical abuse or combat exposure. Childhood sexual abuse leads to long-term psychological consequences such as chronic depression, PTSD, and suicide-related outcomes. Social use of marijuana, planning for employment, and having a spouse who is employed are not characteristics that increase the veteran's risk for suicide.

A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply. Acetaminophen Ketoconazole Valproic acid Diazepam Insulin

acetaminophen ketoconazole valproic acid Many medications (including acetaminophen, ketoconazole, and valproic acid) are responsible for hepatic dysfunction and disease. A thorough medication history should address all current and past prescription medications, over-the-counter medications, herbal remedies, and dietary supplements.

for hepatic encephalopathy: 2 actions to take 2 parameters to monitor

actions to take: administer lactulose assess for asterixis parameters to monitor: neurologic status safety measures

asterixis:

aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.

viral hepatitis B / C / D etiology

blood and sex transmitted

Chronic Myelogenous Leukemia (CML)

both mature and immature granulocytes are present in large numbers in the marrow and blood

The nurse is completing a health history on a client who was deployed during the Gulf War. For the use of which substance should the nurse assess this client? alcohol marijuana opioids heroin

alcohol Explanation: Alcohol use disorder (AUD) is one of the most prevalent mental disorders in the United States. Veterans are more likely to use alcohol than other substances. They also are more likely to use alcohol than their non-veteran counterparts. While in the military, service members can face dishonorable discharge or criminal prosecution for a positive drug test. Within one year of deployment, 39% of veterans screen positive for AUD. There is no evidence that the client would be using the substances of heroin, opioids, or marijuana.

The nurse is assessing a client with posttraumatic stress disorder (PTSD) who was in active duty during Operation Iraqi Freedom. For which additional condition should the nurse assess this client? musculoskeletal diseases alcohol use disorder neurologic conditions cardiovascular disease

alcohol use disorder Explanation: The prevalence of PTSD in veterans is difficult to estimate because of the various diagnostic criteria that have been used over several decades. Experts agree that veterans who served in Iraq and Afghanistan report higher rates of PTSD than nonveteran population. Co-occurring disorders, particularly alcohol use disorder, are common in veterans with PTSD. Neurologic conditions, cardiovascular disease, and musculoskeletal diseases are not identified as co-occurring with PTSD.

toxic hepatitis big thing

all about the amount you were exposed to the thing and how long you were exposed to it - there is no cure for toxic hepatitis,

nonmyeoloablative stem cell transplant

also called Mini-Transplants; does not completely destroy bone marrow cells - chemo doses are lower and aimed at destroying malignant cells (without completely killing the bone marrow) and then supresses the recipients immune system to allow engraftment of donor stem cells. - lower doses of chemo is associated with less organ toxicity and infection, and be used for OLDER patients or those with preexisting organ dysfunction for who high dose chemo would be prohibitive. - after engraftment, the donor cells should create a graft versus tumor effect. - before engraftment, patients are at a high risk for INFECTION, SEPSIS, AND BLEEDING

acute symptoms of cancer treatment (chemo and radiation) toxicity

anorexia, n/v, diarrhea, alopecia, dry skin, skin ulcers, dry mouth, anemia, leukopenia, thrombocytopenia, fatigue, malaise

A psychiatric-mental health nurse is teaching the family members of a client about strategies for engaging with their family member who has recently been diagnosed with posttraumatic stress disorder (PTSD). The nurse should encourage the client's family to: anticipate that the client is likely to be irritable and withdrawn at times. create social interaction for the client even if the client is actively opposed to socializing. expect that the client will sleep for short periods of time, several times per day. ensure the client takes benzodiazepines at the same time each day.

anticipate that the client is likely to be irritable and withdrawn at times. Explanation: Clients with PTSD are prone to irritability and social withdrawal. In most cases, it is counterproductive and unethical to force a client into social situations if he or she is openly opposed to them. Sleep disruptions are expected, but there is no recognized pattern of frequent naps; insomnia is typical. Benzodiazepines are not normally used for the treatment of PTSD.

After radiation treatment, a client reports dryness, redness, and scaling of his skin occurring within the designated treatment markings. The nurse should instruct the client to take which of the following actions?

apply hydrating lotions

During a group therapy session, a female veteran of the Vietnam War relates a situation when a commanding officer forced a sexual act while the client was in the shower. In which way will this client's sexual experience be categorized? ideation assault insubordination harassment

assault Explanation: Military sexual trauma (MST) is not a new phenomenon but has become more visible because victims are more likely to report the incident. In earlier wars, such as World War II and Vietnam, MST was underreported. The client is describing sexual assault, which includes forcing a person to engage in a sexual act. This act is more likely to occur when a female was alone and on duty. The situation that the client relates contains the characteristics of sexual assault. Sexual ideation is not a descriptive term for MST. Sexual harassment includes comments and jokes that involve sexual innuendo. The client's situation was more than sexual harassment. Sexual insubordination is not a descriptive term for MST.

patient assessment for oncologic disorders

assess for: - physical findings that may predispose the patient to cancer, such as multiple colon polyps or presence of more than one tumor. if tumor was previously diagnosed, inquire about the age of the patient when the tumor was first noted. - skin findings, such as atypical moles, that may be related to familial melanoma syndromes - multiple cafe-au-lait spots, axillary freckling, and two or more neurofibromas assosciated with neurofibromatosis type 1. - facial trichelommomas, mucosal papillomatosis, multinodular thyroid goiter, or tyroid adenomas, macrocephaly, fibrocystic breasts, and other fibromas or lipomas related to Cowden syndrome - assess for lifestyle risks (smoking, obesity, alcohol use) - determine occupational or environmental hazards that may generate exposure to inhaled chemicals, gases, or other irritants (toxic metals, asbestos, radon)

pancreatitis

autodigestion inability of enzymes leaving; necrotic tissue

primary prevention for cancer

avoid known carcinogens change lifestyle, diet public and patient education

Chemotherapy dosing

calculate dose based on body weight or body surface, make sure there is a signed informed consent, and educate pt on side effects.

Mitotane

causes selective destruction of adrenocortical cells-- used in Cushing's Disease

malignancy (big thing)

cells start losing their function!! cells or processes that are characteristic of cancer

benign cancer cells

cells that are not cancerous

hepatic encephalopathy:

central nervous system dysfunction frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma

how to prevent overfeeding with enteral feeding

check residuals q 4-6 hours - stop feed if residuals are too high - call MD - normally they will say to start reglan or something and then start feed back at a slower rate

Laennec's Cirrhosis

chronic alcohol use scar tissue surrounds portal areas (most common type)

biliary cirrhosis

chronic obstruction/autoimmune (scarring around bile ducts, less common)

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:

cirrhosis. Explanation: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

antivirals / meds for hep c

combo peginterferon alfa 2a/ribovirun

sarcoma

connective or supportive - bone - cartilage - adipose - smooth muscle - skeletal muscle - fibrous tissue - membranes lining body cavity - blood vessels - most common: form of cancer of the bone - rare: arises from within the bone - very rare: arises from deep soft tissue - most common in young children - often involves long or flat bones - most often related to asbestos exposure - with liver involvement, it may be r/t occupational to vinyl chloride monomer (the stuff that was in that train that derailed recently??!!?????) - osteosarcoma - chondrosarcoma - liposarcoma - leiomyosarcoma - rhabdosarcoma - fibrosarcoma - mesothelial sarcoma or mesothelioma - angiosarcoma

myeloablative stem cell transplant

consists of giving patients high-dose chemotherapy and occasionally total-body irradiation to prevent the patient from rejecting the donor stem cells engraftment: process where the collected stem cells are infused IV into the patient and the cells travel to the sites in the body where they produce bone marrow and establish themselves. take 8 to 10 days normally to completel engraftment. one engraftment is complete: new bone marrow is functional and begins producing RBCs, WBCs, and platelets.

The nurse prepares to administer the lavage solution to a client having a colonoscopy completed. The nurse stops and notifies the physician when noting that the client has which condition?

inflammatory bowel disease Explanation: The nurse stops administering the lavage solution and notifies the physician when the nurse notes that the client has inflammatory bowel disease. Another contraindication for use of lavage solution is intestinal obstruction. Chronic obstructive pulmonary disease (COPD), congestive heart failure, and pulmonary hypertension are not contraindications to administration of lavage solution in preparation for a colonoscopy.

A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. The nurse explains that the expected outcome of this surgery is

decrease in tumor size to improve the effects of other therapy

Homelessness can cause a multitude of problems for children, some of which include ... developmental delays and learning difficulties. depression and suicidality. aggression and depression. anxiety and lack of concentration.

developmental delays and learning difficulties. Explanation: Homeless children commonly experience developmental delays, depression, anxiety, and learning difficulties. Their homelessness may be a source of shame. They also may demonstrate resiliency to their multiple stressors

diabetes insipidus rhyme

diabetes insipidus the opposite you'll see see peepee, give IVs vasopressin they need! high output, sodium pounds lost and Low specific gravity

steroid teaching

do not abruptly stop taking, masks s/sx of infection, report unusual stress or illness so dose can increased, may cause decreased wound healing monitor for GI bleed monitor for cushings disease symptoms (round red face, hump on neck, new stretch marks, weight gain at midsection, excessive facial hair, acne, easily bruised, skin slow healing cuts, irregular menstruation, decreased libido, skin darkening)

benign cells -- metastasis

does NOT spread by metastasis

manifestations of peptic ulcers

dull gnawing pain or burning in the midepigastrium; heartburn and vomiting may occur

Cystic fibrosis, a genetic disorder characterized by pulmonary and pancreatic dysfunction, usually appears in young children but can also affect adults. If the pancreas was functioning correctly, where would the bile and pancreatic enzymes enter the GI system?

duodenum Explanation: The duodenum, which is approximately 10 inches long, is the first region of the small intestine and the site where bile and pancreatic enzymes enter.

Primary hypothyroidism

dysfunction/autoimmune disorder causing not enough thyroid hormone to be excreted

portal hypertension:

elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver

During an assessment at the Veterans Hospital, a client who was recently discharged from active duty is concerned because rent is coming due and the client is unable to obtaining employment. Which referral should the nurse make for this client? community health clinics employment services homeless shelters medication program

employment services Explanation: The VHA has multiple programs to support veterans who are homeless or at risk of being homelessness. The VA conducts coordinated outreach to seek out veterans in need of assistance. Veterans who are homeless or at risk of being homeless are connected with community employment services. There is no evidence that the client is homeless so a referral to homeless shelters is not required. There is no evidence that the client needs assistant with medications or services offered by a community health clinic.

chronic gastritis symptoms

epigastric discomfort, anorexia, heartburn after eating, belching, sour taste in the mouth, nausea and vomiting, i ntolerance of some foods. May have vitamin deficiency due to malabsorption of B12

carcinoma

epithileal - glandular epithelium - squamous epithelium - account for 80-90% of all cancers - organs or glands capable of excretion - covers or lines all external and internal body surfaces - adenocarcinoma, squamous cell carcinoma

A client has been referred for care because the client's primary care provider suspects that the client has posttraumatic stress disorder (PTSD) following a motor vehicle accident. When working with this client, the psychiatric-mental health nurse should begin by: eliciting the objective facts about the incident. establishing therapeutic rapport with the client. reassuring the client that the client is having an expected response to such an incident. gently encouraging the client to talk about the incident.

establishing therapeutic rapport with the client. Explanation: Therapeutic rapport is absolutely foundational to all other interactions between the client and the nurse. As such, it must precede the details of assessment. The nurse must be careful not to provide false reassurance, and any reassurance that is given must exist in a context of rapport.

In patients in DKA, how often do you monitor their blood sugar?

every hour

risk factors for peptic ulcers

excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency

A client who is a bus driver was involved in an accident in which two of her passengers died. The client blames herself for their death even though she was exonerated in the follow-up investigation. To help the client see the event more realistically, the nurse should: facilitate a referral for cognitive restructuring therapy. discuss the possibility of SSRIs with the primary care provider. discuss the possibility of benzodiazepines with the primary care provider. arrange for the client to receive eye movement, desensitization, and reprocessing (EMDR) therapy

facilitate a referral for cognitive restructuring therapy. Explanation: Cognitive restructuring aims to help the client reframe an event in a more realistic way. EMDR addresses the emotional impact of the events. Medications aid with anxiety and mood but do not directly change the client's view of events.

viral hepatitis (A and E) etiology

fecal oral route

A nurse is reviewing risk factors that lead to the development of posttraumatic stress disorder (PTSD) in the veteran population. Which finding would lead to an increased risk for development of PTSD? participation in community involvement male gender with one deployment female gender with one deployment median income above the poverty level

female gender with one deployment Explanation: Risk factors for the development of PTSD include but are not limited to high combat exposure, concussion history, high exposure to stress in the last year with limited social support. Other predictors include female gender, high lifetime trauma, and low social support. Median income above the poverty level may still present an issue, but being female with one deployment would be considered as an increased risk factor. Participation in community involvement reflects adequate social support.

what causes dumping syndrome

fluid shift in abdomen results of rapid gastric emptying/high carb injection

syngeneic stem cell transplant

from an identical twin

addison's disease complications: hypoglycemia (treatment)

give glucagon monitor for symptoms

water deprivation test

give vasopressin sq if urine concentration increases = primary DI

what meds can cause Hyperglycemia Hyperosmolar Syndrome

glucorticoids, thiazide diuretics, phenytoin, beta blockers, calcium channel blockers

classic symptoms for peptic ulcer disease

gnawing, burning pain in mid epigastric region of abdomen

orthotopic liver transplantation (OLT)

grafting of a donor liver into the normal anatomic location, with removal of the diseased native liver

paraesophageal hiatal hernia

greater curvature of the stomach herniates through a secondary opening in the diaphragm and lies alongside the esophagus

benign cells -- mode of growth

grows by expansion and does not infiltrate the surrounding tissues; usually encapsulated

symptoms of water intoxication

headache, confusion, muscular weakness, lack of concentration, poor memory, loss of appetite, convulsions, death

leukemia

hematopoietic cells in the bone marrow - WBCs - lymphocytes - RBCs may involve various cells lines produced in the bone marrow involves overproduction of RBCs and is assosciated with increased levels of WBCs and platelets; also risk of additional bone marrow disease - myelogenous - lymphocytic - erythremia - acute myelogenous leukemia - acute lymphocytic leukemia - polycythemia vera

peptic ulcer disease complications

hemorrhage perforation gastric outlet / pyloric obstruction

a nurse is assessing a client who has a long history of smoking and is suspected of having laryngeal cancer. the nurse should anticipate that the client will report that her earliest manifestation was dysphagia. hoarseness. dyspnea. weight loss.

hoarseness. Laryngeal cancer, a malignant tumor of the larynx, is most often caused by long exposure to tobacco and alcohol. Hoarseness that does not resolve for several weeks is the earliest manifestation of cancer of the larynx because the tumor impedes the action of the vocal cords during speech. The voice may sound harsh and lower in pitch than normal.

parathyroidism complications

hypercalcemic crisis Ca >13. Neuro, cardiac, and kidney symptoms.

Cushing's

hypersecretion of glucocorticoid hormone (cortisol)

symptoms of primary aldosteronism

hypertension that does not respond to treatment weakness polyuria polydipsia hypokalemia

The nurse determines one or two bowel sounds in 2 minutes should be documented as

hypoactive. Explanation: Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Normal bowel sounds are heard every 5 to 20 seconds. Hyperactive bowel sounds occur when 5 or 6 sounds are heard in less than 30 seconds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

While completing a health history, a client states, "I want you to write down that I am a veteran." In which way will the nurse categorize the client's statement? identifies as a veteran wants preferential treatment expects respect for serving in the military deserves benefits reserved for former military personnel

identifies as a veteran Explanation: A veteran identity is the degree to which the veteran role is central or important to how a client thinks about themselves and how they want others to view them. Veteran identify can be measured by specific statements about the veteran status. The client saying to write down the status of being a veteran indicates the client identifies as a veteran. The client's statement does not indicate that the client wants preferential treatment, expects respect for serving in the military, or deserves benefits reserved for former military personnel.

Primary Addison's Disease causes

idiopathic autoimmune dysfunction, radiation to abdomen, adrenalectomy, cancer

constructional apraxia:

inability to draw figures in two or three dimensions

Which response is a parasympathetic response in the GI tract? increased peristalsis decreased gastric secretion decreased motility blood vessel constriction

increased peristalsis Explanation: Increased peristalsis is a parasympathetic response in the GI tract. Decreased gastric secretion, blood vessel constriction, and decreased motility are sympathetic responses in the GI tract.

depersonalization/derealization disorder

individuals feel detached from their own mind and body (depersonalization) or from their surroundings (derealization) temporary change

what are peptic ulcers associated with

infection of H. pylori

cholecystitis

inflammation of the gallbladder

gastritis

inflammation of the lining of the stomach can be nonerosive or erosive

Hypothyroidism

insufficient production of thyroid hormones

Which term describes a gastric secretion that combines with vitamin B12 so that it can be absorbed?

intrinsic factor Explanation: Intrinsic factor, secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum. In the absence of intrinsic factor, vitamin B12 cannot be absorbed and pernicious anemia results. Amylase is an enzyme that aids in the digestion of starch. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells. Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein.

hypoparathyroidism symptoms

irritability tetany

addison's disease complications: hyperkalemia

kayexalate insulin with dextrose diuretics

nephrogenic diabetes insipidus

kidneys do not respond to ADH (can be seen after head injury, neurosurgery, spinal cord injury)

diagnostics of cirrhosis

labs: Early ALT/AST elevation albumin RBC/Hgb/plt; pt/INR ammonia/creatinine US CT MRI Biopsy

diagnosis of pancreatitis

labs: amylase elevated in early stages, Lipase elevated later stages, WBC, bili, glucose; plt, Ca+, mg+ Imaging: CT with contrast

primary diabetes insipidus

lack of production/release of ADH

primary aldosteronism treatment

laparoscopic surgical removal of adrenal tumor after surgery: - give corticosteroids - IVFs - spironolactone to preserve potassium - poss. vasopressors to maintain BP postop

adjustment disorder

less severe, can make you irritable, causes dysfunction and mood changes, is an emotional disturbance caused by ongoing stressors within the range of common experience

what does excessive aldosterone cause

less sodium excretion in kidneys

lavage tubes

levin and salem pump usually larger bore gastric (salem) sump: double lumen to allow for air ventilation. keep reflux via vent by - keep above waist - using anti-reflux valve

dissociative amnesia

loss of memory for personal information or periods of time, either partial or complete

What is the recommended dietary treatment for a client with chronic cholecystitis?

low-fat diet Explanation: The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.

Cancer is the second leading cause of death in the United States, second only to heart disease. Half of all men and one third of all women will develop cancer during their lifetimes. Which types of cancer have the highest prevalence among both men and women? colon and skin lung and skin lung and colon skin and brain

lung and colon Explanation: Common cancers in men include prostate, lung, and colon. Breast, lung, and colon cancer most commonly affect women.

late effects of cancer treatment (chemo and radiation) toxicity

lung, CNS, and bladder: fibrosis atrophy ulceration necrosis dysphagia incontinence cognitive impairment sexual dysfunction

lymphoma

lympcytes two main classes: - may involve lymph nodes - may involve body organs non-hodgkin lymphoma hodgkin lymphoma B-cell lymphoma T-cell lymphoma

nursing management in patients receiving radiation therapy

manage symptoms assess skin assess nutritional status assess general feelings of well-being explain to patient that if these symptoms occur (like fatigue), that this is a result of treatment and is not representative of deterioration or progression of the disease. for fatigue: - recommend aerobic exercise and explain that this is most effective when adherence is high

esophageal varices treatment

meds: - vasopressin - blood transfusion - IVF interventions: - cold saline lavage (to cause vasoconstriction) - esophagogastric balloon tamponade - ligation

treatment of hyperthyroidism

meds: Thionamides, beta blockers, iodine solutions more invasive: Thyroidectomy radioactive iodine therapy

cushing's disease treatment

meds: - Ketoconazole - corticosteroid inhibitor - Mitotane - selective destruction of adrenocortical cells. Chemotherapy surgery: Hypophysectomy (removal of pituitary gland) Adrenalectomy

purpose of enteral feedings

meet nutritional requirements when oral intake is inadequate or not possible, and the GI tract is functioning

A nurse is taking care of a veteran client with multiple health issues at the clinic. Which of the following would be considered as a service-connected disability? history of hypertension 10 years after deployment mental health issues on return to civilian life active military service years during the Gulf War had an appendectomy during years of military service

mental health issues on return to civilian life Explanation: A service-connected disability represents an injury, disease, or disability that active duty either caused or activated. Research has shown that the highest number of veterans with a service-connected disability served in the Gulf War and/or following 9/11. A history of hypertension 10 years following deployment may not be related to active duty but rather a consequence of aging and/or genetic history. The fact that the active military services years were during the Gulf War does not specifically indicate the presence of a service-connected disability. Having an appendectomy during years of military service is an example of an intervention for an acute illness. Having mental health issues on return to civilian life is indicative of a service-connected disability.

A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications?

metabolism of medications Explanation: Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances.

Fludrocortisone considerations

monitor HTN and weight know that some edema is to be expected

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are

normal. Explanation: Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are hypoactive. normal. absent. sluggish.

normal. Explanation: Normal bowel sounds are heard every 5 to 20 seconds. Hypoactive bowel sound is the description given to auscultation of one to two bowel sounds in 2 minutes. Sluggish is not a term a nurse would use to accurately describe bowel sounds. The nurse records that bowel sounds are absent when no sound is heard in 3 to 5 minutes.

how to prevent aspiration pneumonia with enteral feedings

o Confirm placement prior to feeds, HOB >30 degree during o Respiratory assessment/VS o Protect airway, give O2 as needed; possible request xray

how to manage dumping syndrome

o Octreotide for severe cases; acarbose slows carb absorption o Slow the formula instillation rate, change to continuous to provide time for carbohydrates and electrolytes to be diluted. o Semi Fowler's for 1 hour

how to prevent diarrhea complications with enteral feedings

o Slow rate, consult dietitian o Skin protection o Evaluate for C. Diff

patients with hiatal hernias should

o have small meals - keep HOB 4-8 inches; - Sit up 1 hour after meals

priority for SIADH

oral fluid restriction 500 - 1000 mls daily

diverticulum (esophageal)

out-pouching of mucosa; pocket Dysphagia, belching, regurgitation of undigested food fixed with surgery

first symptom of renal cancer

painless hematuria

Parenteral Nutrition (PN)

parenteral nutrition via PIV with <10% dextrose (MUST HAVE IV DEXTROSE THAT IS LESS THAN 10% OR ELSE IT CAN CAUSE PHLEBITIS AND OR NECROSIS OF TISSUE)

The nurse is caring for a veteran who was discharged from active duty 6 months ago. During assessment, which area(s) will the nurse prioritize? Select all that apply. satisfaction with transitioning to civilian life symptoms of chronic illnesses status of recommended vaccinations evidence of mental health conditions particular health concerns

particular health concerns symptoms of chronic illnesses satisfaction with transitioning to civilian life evidence of mental health conditions Explanation: The transition from the structured military life to civilian life can be difficult and stressful. The first year after discharge from the military is a high-risk period. The correct responses are those dealing with the fact that many newly separated veterans report more health concerns and chronic health conditions. Work satisfaction often deteriorates shortly after beginning a civilian job so the nurse should ask about the transition to civilian life, and many newly separated veterans report mental health conditions. The status of recommended vaccinations is not identified as a priority for this population of clients as most veterans have had medical care since enlistment and should be up to date on all vaccinations upon discharge.

autologous stem cell transplant

patients own stem cells are collected, stored, and re-infused post chemo treatment

signs of clotting problems

petechiae, bloody drainage

where do you put the ostomy appliace in relation to the stoma?

place the appliace around the widest part of the stoma

myeloma

plasma cells produced by B-cell lympthocytes, plasma cells produce antibodies multiplemyeloma commonly seen in vietnam veterans exposed to Agent Orange

post necrotic cirrhosis

post viral/hep/meds (broad bands of scar tissue)

A veteran client presents with a weak veteran identity. What type of behavior should the nurse anticipate? prefers to remain alone willingness to participate in community groups adequate functional ability compliance with health care

prefers to remain alone Explanation: A strong veteran identity is associated with positive self-esteem and self-definition and affords protective factors as they relate to mental health issues. An individual with a weak veteran identity is at risk for mental health issues; therefore, the nurse would expect that the individual might prefer to remain alone. Compliance with health care, willingness to participate in community groups ,and adequate functional ability would be aligned with a strong veteran's identity.

A veteran client presents with a weak veteran identity. What type of behavior should the nurse anticipate? willingness to participate in community groups prefers to remain alone adequate functional ability compliance with health care

prefers to remain alone Explanation: A strong veteran identity is associated with positive self-esteem and self-definition and affords protective factors as they relate to mental health issues. An individual with a weak veteran identity is at risk for mental health issues; therefore, the nurse would expect that the individual might prefer to remain alone. Compliance with health care, willingness to participate in community groups ,and adequate functional ability would be aligned with a strong veteran's identity.

increased TSH, decreased T3 and T4

primary hypothyroidism

endoscopic variceal ligation (EVL):

procedure that uses a modified endoscope loaded with an elastic rubber band passed through an overtube directly onto the varix (or varices) to be banded to ligate the area and stop bleeding (synonym: variceal banding)

chronic gastritis

prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori. May also be associated with some autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile

healthy stoma

ranges in color from deep pink to brick red & is shiny and moist

A client tells the nurse that the stool was colored yellow. The nurse assesses the client for

recent foods ingested. Explanation: The nurse should assess for recent foods that the client ingested, as ingestion of senna can cause the stool to turn yellow. Ingestion of bismuth can turn the stool black and, when occult blood is present, the stool can appear to be tarry black.

what kind of insulin is given as an insulin drip

regular insulin

Palliation refers to the spread of cancer cells from the primary tumor to distant sites. the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow. relief of symptoms associated with disease and promotion of comfort and quality of life. hair loss related to the treatment of cancer.

relief of symptoms associated with disease and promotion of comfort and quality of life. Explanation: Palliation is the goal for care in patients with terminal cancer. Alopecia is the term that refers to hair loss. Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites. Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.

Prophylactic surgery for cancer

removal of nonvital tissues or organs that are likely to develop cancer

A nurse is performing a screening assessment on an enlisted military client. Which finding should the nurse expect when obtaining a health history in comparison to an officer military client? strong spiritual identity reports a strong work ethic reports difficult family relationships reports fewer problems

reports difficult family relationships Explanation: Enlisted personnel consistently report poorer health, vocational, and social outcomes compared to their officer counterparts. Therefore, the nurse would identify the reporting of difficult family relationships as being significant.

non viral hepatitis: toxic hepatitis

resembles viral Recovery related to exposure time and early identification

growth hormone disorder (acromegaly)

results from hypersecretion of Growth Hormone during adulthood

decreased TSH, decreased T3 and T4

secondary hypothyroidism

A client who was a former enlisted member of the Army states that learning to delay personal health care needs was a part of basic and daily training. Which value will the nurse recognize this client is describing? pride honor loyalty self-sacrifice

self-sacrifice Explanation: The military culture is structured to protect and defend the United States. The values, beliefs, and behaviors acquired in the military often last a lifetime. Specific values are instilled by officers in enlisted members. The client's comment indicates the value of self-sacrifice that was a part of basic and daily training while enlisted in the military. The client's comment does not describe the military values of pride, honor, or loyalty.

Addisonian crisis s/s

severe hypotension, cyanosis fever N/V/D tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, pallor headache abdominal pain weakness, confusion restlessness

A nurse is interviewing a client who states living at a private homeless agency. Which type of homelessness should the nurse document in the client's chart? stable sheltered federal unsheltered

sheltered Explanation: Homeless shelters provide temporary or transitional housing operated by public and private agencies for individuals and families who have not stable housing. Unsheltered homeless live in places that are not used for housing such as cars, parks, abandoned building, tents, and/or bus/train stations. The nurse is aware that safety, security and food are provided at sheltered housing.

complications of pancreatitis

shock DM1 atelectasis DIC MODS

prevention of DKA

sick day rules!! don't skip your insulin! don't ration your insulin! do frequent blood glucose checks!

Which procedure is performed to examine and visualize the lumen of the small bowel? panendoscopy peritoneoscopy colonoscopy small bowel enteroscopy

small bowel enteroscopy Explanation: Small bowel enteroscopy is the endoscopic examination and visualization of the lumen of the small bowel. Colonoscopy is the examination of the entire large intestine with a flexible fiberoptic colonoscope. Panendoscopy is the examination of both the upper and lower GI tracts. Peritoneoscopy is the examination of GI structures through an endoscope inserted percutaneously through a small incision in the abdominal wall.

A nurse is counseling a veteran with alcohol use disorder (AUD). Which factor(s) should the nurse identify as the highest risk factor(s) for the development of AUD? Select all that apply. solitary lifestyle attends religious services recent return from deployment family social support cultural beliefs

solitary lifestyle recent return from deployment Explanation: Risk factors for AUD include but are not limited to trauma, exposure to military stress, and return to civilian life. Protective factors for AUD include but are not limited to resilience, purpose in life, dispositional gratitude, religiosity/spirituality, and secure attachment. A solitary lifestyle and recent return from deployment would be considered risk factors.

diet and fluid intake for patients with ostomies

some food cause odor (fish, eggs, garlic) Foods such as spinach and parsley act as deodorizers in the intestinal tract; foods that cause odors include asparagus, cabbage, onions, and fish. high fiber foods for 1st 2 months

When planning care for a homeless person, the nurse must build into the plan the fact that ... clients have knowledge and access to public health services. the client can easily access adequate public transportation. something as simple as not having an address may prevent the client from receiving care. their belongings will be safe while they are receiving care at a clinic.

something as simple as not having an address may prevent the client from receiving care. Explanation: Barriers to the homeless receiving care include lack of insurance; lack of transportation; eligibility criteria, which may require an address; loss of identification (a frequent requirement for accessing services); lack of knowledge of available services; fear of having to leave, and possibly lose, possessions by attending clinic appointments; concern over missing meals or a place in line for a shelter bed; and fear of scrutiny by caregivers.

Secondary Addison's Disease causes

steroid withdrawal, hypophysectomy, pituitary neoplasm, radiation to pituitary or brain

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:

subnormal serum glucose and elevated serum ammonia levels. Explanation: In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

acute hepatic failure

sudden, severe onset of acute liver failure that occurs within 8 weeks after the first symptoms of jaundice (formerly: fulminant hepatic failure)

colostromy

surgical creation of an artificial excretory opening into large intestine

adrenalectomy

surgical removal of one or both adrenal glands Post-operation, patient will be in ICU - glucocorticoid/hormone replacement. Monitor for: adrenal crisis (hypotension, tachycardia/pnea, nausea, headache), have patient: decrease Na intake increase K, protein, Ca, Vit D. intake

hypophysectomy

surgical removal of the pituitary gland Monitor: - Na - K - Chloride - For CSF leak - For bleeding - neuro status give: - glucocorticoid before, during, and after surgery

foreign bodies of esophagus

swallowed item that will not pass - s/sx: difficulty breathing, choking, coughing, etc - can use IV Glucagon to relax esophageal muscle during retrieval of FB - fixed with EGD

fetor hepaticus

sweet, slightly fecal odor to the breath, presumed to be of intestinal origin

thyroidectomy complications: hypocalcemia

symptoms: Trousseau sign (hands), Chvostek sign (face twitch) treatment: IV calcium gluconate

SIADH

syndrome of inappropriate antidiuretic hormone secretion

levothyroxine

synthetic thyroid hormone Take on empty stomach. Other drugs (warfarin, digoxin, insulin, fiber, Ca+, Fe, antacid) can interact Caution in CAD

Graft vs. Host Disease (GVHD) symptoms

tachycardia fever RUQ pain change in bile color/increased jaundice increase alt/ast

The nurses assesses the client for blood in the stool due to an upper GI condition. The nurse understands that if there is blood in the stool, the stool will be which color?

tarry black Explanation: Blood that is shed in sufficient quantities from the upper GI tract produces a tarry-black stool. Blood from the lower portion of the GI tract will appear bright or dark red. A milky white stool is indicative of a client who received barium. A green stool is indicative of a client who has eaten spinach.

A nurse is caring for a 7-year-old child. Nurses' Notes 0830: Child was brought in by parents for unexplained bruising and red spots on the child's shoulders, thighs, and back. Parents report child has had a cold for more than 2 months and over-the-counter medications have not helped relieve the cold symptoms. Lung sounds clear. Child moves all extremities well with some swelling noted in knees and elbows. Abdomen soft with active bowel sounds. 1000: Parents report child had small nosebleed "a few minutes ago," and the child reports "my arms and legs hurt all over." Child's nosebleed has been resolved with only a small amount of blood noted on tissues. Vital Signs 0830: Temperature 38° C (100.4° F) Heart rate 100/min Respiratory rate 20/min Blood pressure 102/64 mm Hg Oxygen saturation 98% on room air 1000: Temperature 38.3° C (101° F) Heart rate 112/min Respiratory rate 24/min Blood pressure 104/62 mm Hg Oxygen saturation 97% on room air Diagnostic Results WBC count 15,000/mm³ (5,000 to 10,000/mm³) Hgb 8 g/dL (10 to 15.5 g/dL) Hct 32% (32% to 44%) The nurse is reviewing the assessment findings and diagnostic results. For each assessment finding, click to specify if the finding is consistent with leukemia, sickle cell anemia, or hemophilia. Each finding may support more than one disease process. Assessment Finding: Reported pain Bruising Temperature WBC count Bleeding

temperature: leukemia and sickle cell anemia bruising: leukemia and hemophilia bleeding: leukemia and hemophilia WBC count: leukemia and sickle cell anemia pain: leukemia, sickle cell anemia, and hemophilia Temperature is consistent with leukemia and sickle cell anemia. The child has an elevated temperature. A child who has leukemia can present with a fever and a persistent mild infection. A low-grade fever can be present in a child experiencing a sickle cell crisis due to inflammation. Bruising is consistent with leukemia and hemophilia. A child who has leukemia often presents with bruising and petechia related to a low production of platelets. A child who has hemophilia can present with bruising related to an alteration in clotting from a factor VIII deficiency. Bleeding is consistent with leukemia and hemophilia. Due to low platelet production, children who have leukemia can have increased bleeding. Hemophilia can result in excessive bleeding from even slight trauma due to a deficiency of the clotting factor VIII. WBC count is consistent with leukemia and sickle cell anemia. The child's WBC count is elevated. A WBC count greater than 10,000/mm³ is a typical manifestation of leukemia. It is related to infiltration of the bone marrow by immature WBCs. WBC count in a child who has sickle cell anemia can be as high as 12,000 to 20,000/mm³ due to chronic inflammation. Pain is consistent with leukemia, sickle cell anemia, and hemophilia. The child reported generalized pain of the extremities. Children who have leukemia might report bone pain related to infiltration of the bones with nonfunctional immature WBCs. During a sickle cell crisis, a child could experience painful bones and joints of the hands and feet due to decreased blood flow. With hemophilia, hemorrhages can occur into the joints, which causes stiffness and aching in the affected joints.

antivirals / meds for hep b

tenofovir, adefovir, interferon alfa - 2b

When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged Tis, N0, M0. The nurse will teach the patient that

the cancer is localized to the cervix

sclerotherapy:

the injection of substances into or around esophagogastric varices to cause constriction, thickening, and hardening of the vessel and stop bleeding

inverse square law

the intensity of radiation decreases with distance from the radiation source

ileostomy

the surgical creation of an artificial excretory opening between the ileum, at the end of the small intestine, and the outside of the abdominal wall

A nurse is caring for client who just returned from the PACU with an IV fluid infusion and an NG tube in place following abdominal surgery. Which of the following data is the priority for the nurse to assess?

the surgical dressing Answer Rationale: When using the airway, breathing, circulation approach to client care, the nurse determines that the assessment priority is monitoring the surgical dressing. Hemorrhage is a major complication postoperatively, so the nurse should assess for early indications of bleeding, such as visible blood stains on the surgical dressing. Covert manifestations of bleeding include rapid, thready pulse, tachycardia, and decreased urine output.

tertiary hypothyroidism

the thyroid gland is normal, the pituitary is also normal, but the hypothalamus is unable to produce thyroid releasing hormone (TRH) to stimulate the pituitary gland

if cortisol levels do not rise after ACTH stimulation test...

then you have Primary Addison's Disease

SIADH rhyme

this hormone stops the peepee brain tumors, trauma, and bad bugs a complication might be low output, sodium gained weight and High specific gravity

secondary hypothyroidism

thyroid isn't being stimulated by pituitary to produce thyroid hormones or it isn't responding to the stimulation

TPN (total parenteral nutrition)

total parenteral nutrition via CVL with >10% dextrose

risks for homeless patients

▪Poor physical health ▫Medication issues ▫Lack immunizations ▫Dental problems ▫Untreated vision/hearing deficits ▫Lack of nutritious foods/clean water ▫Poor hygiene

radiation therapy

treatment of neoplastic disease using ionizing radiation to impede the proliferation of malignant cells - can be curative, control, or palliative (palliative can be used to relieve symptoms of locally advanced or metastatic disease, OR to treat ONCOLOGIC EMERGENCIES, such as Superior Vena Cava Syndrome, bronchial airway obstruction, or spinal cord compression) - can be external or internal - brachytherapy (internally placed radiation device) - toxicity (often seen within 2 weeks of initiation of treatment and occur when normal cells within the treatment area are damaged and cellular death exceeds regeneration.

true or false: patients receiving TPN should have a BMP drawn daily

true

SIADH causes

tumors, increased intrathoracic pressure TBI, TB, meds (SSRI, opioids, fluoroquinolone antibiotics)

cancer management will always be based on

type, stage, and grade - cure - control - palliation

neoplasia

uncontrolled cell growth that follows no physiologic demand

The client describes a test previously completed to detect a small bowel obstruction prior to admission to the hospital. The client states that the test involved insertion of a tube through the nose and lasted over 6 hours. The nurse determines which test name should be documented?

upper GI enteroclysis Explanation: Enteroclysis is a double contrast study where a duodenal tube is inserted and 500 to 1000 mL of thin barium sulfate suspension and then methylcellulose is infused. Fluoroscopy is used to visualize the filling of the intestinal loops over a period of up to 6 hours. The test is used for detection of small bowel obstruction and diverticuli. Abdominal ultrasound, magnetic resonance imaging, and positron emission tomography do not involve insertion of a duodenal tube.

A client who was stateside during a foreign war is experiencing chronic arm pain. For which information should the nurse assess this client? length of time enlisted use of the arm while enlisted age when enlisted barrack location in the states

use of the arm while enlisted Explanation: The prevalence of chronic pain occurs more frequently in veterans than non-veterans. In a review of the incidence, prevalence and risk factors for musculoskeletal pain, inflammation, and pain from overuse comprised the largest proportion of injury in all nondeployed military personnel. Asking the client about the use of the arm while enlisted will help determine if the client's arm pain is caused by overuse. The age when enlisted, length of time enlisted, or barracks location in the states will not help determine the reason for the client's chronic arm pain.

Dexamethasone suppression test

used to test for Cushing's, this blood analysis used to tests for cortisol levels after administration of synthetic glucocorticoid (dexamethasone)

hematopoietic stem cell transplantation

used to treat several malignant and nonmalignant diseases 5 types: - allogenic - autologous - syngeneic - myeloblative - nonmyeloablative

benign cells -- rate of growth

usually slow

carciongenesis etiology

viruses and bacteria physical agents chemicals genetic or familial factors lifestyle factors hormones

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:

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

The nurse recognizes which change of the gastrointestinal system is an age-related change? weakened gag reflex hypertrophy of the small intestine increased motility increased mucus secretion

weakened gag reflex Explanation: A weakened gag reflex is an age-related change of the GI system. There is decreased motility, atrophy of the small intestine, and decreased mucus secretion.

cushing's syndrome treatment

wean off of steroids

a nurse is performing discharge teaching with a client about the care of a newly created ileal conduit. the nurse should instruct the client to empty the appliance twice a day. daily at bedtime. when the bag is 2/3 full. when the bag is full.

when the bag is 2/3 full. An ileal conduit is used to divert urine outside of the body when the urinary bladder has been removed. The conduit cannot store urine the way the bladder did; therefore, urine will be flowing continuously, and an appliance must be worn as a collecting device. The bag should be emptied when it becomes 2/3 full to prevent leakage, skin irritation, and infection.

when do you stop giving IV insulin in DKA patients

when: BS <200, pH >7.3, bicarb >18, anion gap <12 (NA - (Cl + HCO2/CO2))

Addison's disease symptoms

wt loss, salt craving, dark pigmentation of skin and mucosa, hypotension, low blood glucose, low serum Na, high serum K+/Ca+, mental changes

if anion gap is > 12

you got metabolic acidosis

Sliding esophageal hernia

°The stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia. [Lower esophageal sphincter isn't working correctly (relaxes)]

cancers influenced by genetics

•Breast •Ovarian •Colorectal •Prostate •Retinoblastoma •Familial melanoma syndrome - familial adenomatous polyposis - cowden syndrome - Li-Fraumeni syndrome - lynch syndrome (hereditary nonpolyposis colon cancer) - multiple endocrine neoplasias types 1 and 2 - von hippel-lindau syndrome - wilms tumor - ataxia telangietasis - endometrial cancer - gastrointestinal stromal tumor - xeroderma pigmentosum

nursing interventions for homeless patients

▪Address basic needs first ▪Educate regarding laws ▪Teach strategies for safety ▪Find local support groups/shelters

expected findings in adjustment disorder

▪Anxiety/Depression ▪Unhealthy responses ▪Lack of coping mechanisms ▪Incongruent reactions ▪Learned helplessness

nursing care for dissociative disorders

▪Decision-making, problem-solving strategies ▪Grounding techniques (clapping hands, touching object, CalmConnect or MeMotion) ▪Avoid over-stimulation ▪Encourage sharing of thoughts/feelings

expected findings in dissociative disorders

▪Depersonalization/derealization ▪Dissociative amnesia (minor details to loss all memories) ▪Dissociative Identity Disorder ▪Displays two or more distinct identities (alters) ▪Each has own mannerisms, habits

diagnostic procedures - DID

▪EEG, r/o TBI/seizure disorder ▪Screening for substance use ▪Assess memory, gaps, contradictions ▪Assess mood ▪Ask about h/o trauma ▪Use screening tools (Dissociative Disorders Interview Schedule, Dissociative Experience Scale)

assessment / risk factors for DID and PTSD

▪H/O trauma, disaster, or emotionally difficult time ▪Traumatic event in loved one's life PTSD may lead to ▪DID ▪Substance abuse ▪Anxiety ▪Depression ▪Severity/proximity of event may be predictive of response ▪Past experiences and coping mechanisms ▪H/O mental disorders ▪Inadequate response following trauma (societal responses, social support, culture)

expected findings for PTSD / ASD

▪Intrusive thoughts/memories ▪Nightmares ▪Flashbacks/dissociative reactions (reliving as though happening at present) ▪Avoidance of reminders ▪Avoiding thinking about event ▪Anxiety, depression ▪Decreased interest in activities ▪Guilt about self/actions ▪Inability to experience positive emotions ▪Detachment ▪Dissociative s/s (amnesia, derealization, depersonalization) ▪Unpredictable responses ▪Aggression ▪Hypervigilance ▪Lack of focus/concentration ▪SI/HI ▪Sleep disturbances

PTSD prevention

▪Monitor for s/s of abuse ▪Report ▪Counseling for child, caregivers ▪Monitor those in high-risk occupations ▪Military members and first responders ▪Early recognition/intervention ▪Before, during, and after traumatic incident ▪Provide breaks, nutritious meals for workers ▪Emotional support for those involved ▪Ongoing support/debriefing for workers ▪Make counseling available to all

strategies to end homelessness

▪Rapid re-housing (RRH) ▪Core components ▪Short-term assistance ▪Housing identification ▪Case workers recruit landlords ▪Rent/move-in assistance ▪Stabilize/navigate barriers ▪Permanent assistance ▪Long-term financial aid ▪Continuing care for medical/mental health ▪Training and employment ▪Assertive Community Treatment ▪McKinney-Vento Act (originally McKinney Act) ▪Passed in 1987 ▪Provides funds/properties for food and shelter ▪Includes adult/child education programs

pharmacology for ASD and PTSD

▪SSRIs-sertraline, paroxetine, fluoxetine, citalopram ▪SNRIs-venlafaxine, duloxetine ▪TCAs-amitriptyline, imipramine ▪Beta blockers-propanolol ▪SSRIs-sertraline, paroxetine, fluoxetine, citalopram ▪Noradrenergic and specific serotonergic anti-depressant (NaSSA, atypical anti-depressants) -Mirtazapine ▪Takes weeks for full effect ▪Don't stop suddenly, no alcohol ▪Wt gain, vision probs, low WBCs ▪Centrally-acting alpha agonist -Prazosin, guanfacine ▪Dizziness, orthostatic hypotension ▪Drowsiness ▪Avoid alcohol

nursing assessment for homeless patients

▪Screening ▪Pregnancy, STDs, TB ▪Nutrition/immunization ▪Hearing/vision ▪Substance abuse ▪History of violence ▪Educational level ▪Support systems/family contact ▪Cultural care

outcomes for homeless patients

▪Strain on mental health ▫Requires resourcefulness ▫Frequently victims of crime ▫Loneliness and self-esteem issues - education interruptions - increased costs for all

nursing care for ASD, PTSD, Adjustment Disorder

▪Trauma-informed care ▪Therapeutic communication ▪SI/HI precautions ▪Stress/anxiety reduction strategies ▪For children, play therapy and involve caregivers