Theories and concepts

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The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing end stage kidney disease?-\p ;

A patient with diabetes mellitus and poorly controlled hypertension

You are performing a Romberg test on your patient. Which describes a positive test?

A positive Romberg test suggests that the ataxia is sensory in nature, that is, depending on loss of proprioception. If a patient is ataxic and Romberg's test is not positive, it suggests that ataxia is cerebellar in nature, that is, depending on localized cerebellar dysfunction instead.

The nurse is caring for a client who exhibits abnormal results of the weber test and rinne test. The nurse should suspect dysfunction involving what cranial nerve?

8 the acoustic nerve

A nurse on a busy medical unit provides care for many patients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which patient?

A patient who has Alzheimer's disease and who is acutely agitated.

A nurse in the ICU is providing care for a client who has been admitted with a hemorrhagic stroke. The nurse is performing frequent neurologic assessments and observes that the client is becoming progressively more drowsy over the course of the day. What is the nurse's best response to this assessment finding?

Report this to the physician as a possible sign of clinical deterioration.

A client has experienced a narcotic overdose. What acid-base imbalance should the nurse expect to observe in this client?

Respiratory acidosis

A patient who is being treated for pneumonia starts complaining of sudden shortness of breath. An arterial blood gas is drawn. The ABG has the following values: ph 7.21, PaCO2 64mm Hg, HCO3 24 mmHg. What does the ABG reflect/

Respiratory acidosis

A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance?

Respiratory alkalosis

While assessing a client who has had knee replacement surgery, the nurse notes that the client has developed a hematoma at the surgical site. This affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for the client?

Risk for Peripheral Neurovascular Dysfunction

An elderly woman living alone at home is incontinent of urine. Which of the following nursing diagnoses would be appropriate for a plan of care?

Risk for impaired skin integrity

The circulating nurse is admitting a client prior to surgery and proceeds to greet the client and discuss what the client can expect in surgery. What aspect of therapeutic communication should the nurse implement?

Use a tone that decreases the patient's anxiety.

A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient requires insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment?

Stress has likely caused an increase in the patients blood sugar levels.

A 42 year old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?

Stress incontinence

A nurse is caring for a patient with a bone tumor. The nurse is providing education to help the patient reduce the risk for pathologic features. What should the nurse teach the patient?

Support the affected extremity with external supports such as splints.

A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the patient about what topic?

current medication use

A patient has been admitted with a head injury and has been diagnosed as hypercalcemic. Which neurologic deficiency will you expect to find?

decreased DTR's

A geriatric nurse is performing an assessment of body systems on an 85- year old patient. The nurse should be aware of what age related change affecting the renal or urinary system?

decreased glomerular filtration rate

A client is diagnosed with an elevated aldosterone levels.The nurse realizes that this finding will affect what aspect of urinary elimination?

decreased urine output

The admitting nurse in a short- stay surgical unit is responsible for numerous aspects of care. What must the nurse verify before the client is taken to the preoperative holding area?

That preoperative teaching was performed

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote?

Always carry a form of fast-acting sugar

The nurse is caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125ml/hr. The patient reports pain at the incision site rated at a 3 on a 0-10 rating scale. During your initial shift the patient has hypokalemia. What other sign or symptoms would you expect this patient to exhibit?

dilute urine

A nurse is preparing to discharge a patient from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage which of the following?

discharge education, the nurse should encourage which of the following Keep an elastic compression bandage on the ankle.

The nurse is assessing a client with a suspected stroke. What assessment finding is most suggestive of a stroke?

facial drooping

An older client receiving intravenous fluids at 175 ml/hr is demonstrating crackles, shortness of breath and distended neck veins. The nurse recognizes these findings as being which complication of intravenous fluid therapy?

fluid volume excess

A nurse is caring for a patient who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the patient does which of the following in order to prevent common complications associated with a hip fracture?

following in order to prevent common complications associated with a hip fracture Increase fluid intake and perform prescribed foot exercises.to prevent DVT

A client is admitted to the medical unit with an exacerbation of multiple sclerosis. When assessing this client, the nurse has the client stick out her tongue and move it back and forth. What is the nurse assessing?

function of the hypoglossal nerve

A client with a documented history of seizure disorder experiences a generalized seizure. What nursing action is most appropriate?

loosen the client's restrictive clothing

All of the following are interventions for incontinence except

request furosemide to be taken three times a day

An elderly client is being discharged home. The client lives alone and has atrophy of his olfactory organs. The nurse tells the client's family that is is essential that the client have what installed in the home?

smoke detector

A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The patient has been placed in traction until his femur can be rodded in surgery. For what early complication should the nurse monitor this patient? SATA

surgery. For what early complications should the nurse monitor this patient Deep vein thrombosis,Compartment syndrome, Fat embolism

A client is receiving a continuous intravenous infusion. What should the nurse document in the medical record about this infusion? SATA

type of solution and flow rate, status of the intravenous catheter site, total intravenous intake for the shift

A nurse is conducting a health history interview for an office patient who is having problems with urinary control. What would be an appropriate interview question to collect further data?

"How have you handled this problem?"

Which of the following is considered a hypotonic solution?

.45% NS

A patient presents to a clinic complaining of a leg ulcer that isn't healing; subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is what?

Staphylococcus aureus

A medical nurse educator is reviewing a patient's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?

The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.

The nurse is reviewing orders for parenteral potassium. Which order is safe for the nurse to implement?

Add 20 mEg of KCL to 1,000ml of IV fluid

A community health nurse is giving an educational presentation about stroke and heart disease at the local senior citizen's center. What nonmodifiable risk factor for stroke should the nurse cite?

Advanced age

Which of the serum levels increase with renal failure? SATA

creatinine and BUN

The nurse is performing the shift assessment of a postsurgical client. The nurse finds that the client's mental status, level of consciousness, speech, and orientation are intact and at baseline, but the client appears unusually restless. What should the nurse do next?

Assess the client's oxygen levels

A nurse is providing ongoing postoperative care to a patient who has had knee surgery. The nurse assesses the dressing and finds it saturated with blood. The patient is restless and has a rapid pulse. What should the nurse do next?

Apply a pressure dressing and report finding

A client has suffered a muscle strain with edema and is reporting pain at 6 on a 10 point scale. The nurse should recommend what action?

Applying a cold pack to the injured site

nurse in a busy emergency department provides care for many patients who present with contusions, strains, or sprains. Treatment modalities that are common to all of these musculoskeletal injuries include SATA

Applying ice,Compression dressings, Resting the affected extremity Elevating the injured limb

A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient?

Avoid hot-water bottles and heating pads.

A family member brings the client to the clinic for a follow- up visit after a stroke. The family member asks the nurse what he can do to decrease his chance of having another stroke. What would be the nurse's best answer?

Stop smoking as soon as possible

A client exhibiting an uncoordinated gait has presented at the clinic. Which of the following is the most plausible cause of this client's health problem?

Cerebellar dysfunction

After surgery, a postoperative patient has not voided for 8 hours. Where would the nurse assess the bladder for distention?

Between the symphysis pubis and the umbilicus

An elderly female with osteoperosis has been hospitalized. Prior to discharge, when teaching the patient, the nurse should include information about which major complication of osteoperosis?

Bone fracture is a major complication of osteoporosis that results when loss of calcium and phosphate increases the fragility of bones

A nurse is planning the care of a client who has undergone orthopedic surgery. What main goal should guide the nurse's choice of interventions?

Improving the client's level of function

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes?

Lately, I drink and drink and cant seem to quench my thirst.

A patient tells the nurse that he has pain and numbness to his thumb, first finger, and second finger of the right hand. The nurse discovers that the patient is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the patient could possibly have what health problem?

Carpal tunnel syndrome

Which of the following statements best describes the care and treatment for a patient admitted with chronic kidney disease?

Care is based on identifying and treating the underlying cause

A nurse measures a patient's 24 hour fluid intake and documents the findings. To be an accurate indicator of fluid status, what must the nurse also do with the information?

Compare the total intake and output of fluids for the 24 hours.

A client is reporting pain. in her casted. leg. The nurse. has administered analgesics and elevated the. limb. Thirty. minutes after administering the analgesics, the client states the pain is unrelieved. The nurse should identify the warning signs of what complication?

Compartment syndrome

A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the injury has become swollen and discolored. The triage nurse recognizes that the patient has likely sustained what?

Contusion

The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patient's kidneys will compensate by secreting what substance?

Renin

A 70 year old man is being discharged from the hospital. What gerontologic considerations need to be considered related to upper and lower urinary tract function?

GFR decreases, thirst decreases, increased risk of urinary incontinence

A patient presents to a clinic complaining of pain in his heel so bad that it inhibits his ability to walk. The patient is subsequently diagnosed with plantar fasciitis. The patient's plan of care should include what intervention?

Gently stretching the foot and the Achilles tendon

A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? SATA

Glycosuria, Dehydration, Hypernatremia, Hyperglycemia

A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? SATA

Decreased excretion of potassium, decreased renal blood flow

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?

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

The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process?

Diffusion

The nurse is packing a client's abdominal wound with sterile, half-inch lodoform gauze. During the procedure, the nurse drops some of the gauze onto the client's abdomen 2 inches (5 cm) away from the wound. What should the nurse do?

Discard the gauze packing and repack the wound with new Iodoform gauze.

The nurse has created a plan of care for a client who is at risk for increased intracranial pressure. The client's care plan should specify monitoring for what early sign of increased ICP?

Disorientation and restlessness

A trauma client in the ICU has been declared brain dead. What diagnostic test is used in making the determination of brain death?

EEG

The surgeons preoperative assessment of a patient has identified that the patient is at a high risk for venous thromboembolism. Once the patient is admitted to the postsurgical unit, what intervention should the nurse prioritize to reduce the patients risk of developing this complication? A) Maintain the head of the bed at 45 degrees or higher. B) Encourage early ambulation. C) Encourage oral fluid intake. D) Perform passive range-of-motion exercises every 8 hours.

Encourage early ambulation

The nurse is admitting a client to the medicalsurgical unit from the PACU. In order to help the client clear secretions and help prevent pneumonia, the nurse should encourage the client to

Encourage the patient to use the incentive spirometer every 2 hours

A nurse is planning the care of an older adult patient with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis?

Ensuring adequate exposure to sunlight

The nurse is caring for an 80- year old client with the medical diagnosis of heart failure. The client has edema, orthopnea and confusion. Which nursing diagnosis is most appropriate for this client?

Excess fluid Volume related to retention of fluids. As evidenced by edema and orthopnea.

A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the body's need for insulin?

Exercise

What should be included in the client's care plan when establishing an exercise program for a client affected by a stroke?

Exercise the affected extremities passively four or five times a day.

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes?

Fasting plasma glucose greater than or equal to 126 mg/dL

A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the patient is febrile and hypoxoic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what complication?

Fat embolism syndrome

When preparing to discharge a client home, the nurse has met with the family and warned that the client may exhibit unexpected emotional responses. The nurse should teach the family that these responses are typically a result of what cause?

Frustration around changes in function and communication

A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A) A combination of protein and carbohydrates, such as a small cup of yogurt B) Two teaspoons of sugar dissolved in a cup of apple juice C) Half of a cup of juice, followed by cheese and crackers D) Half a sandwich with a protein-based filling

Half of a cup of juice, followed by cheese and crackers

What neurologic assessment should the nurse perform to gauge the client's function of cranial nerve 1?

Have the client identify familiar odors with the eyes closed

A nurse is caring for a client diagnosed with Meniere's disease. While completing a neurologic examination of the client, the nurse assesses cranial nerve 8. The nurse would be correct in identifying the function of this nerve as what?

Hearing and equilibrium

A nurse is teaching a preoperative patient how to cough effectively. What can the nurse tell the patient to do to facilitate coughing?

Hold a pillow or folded bath blanket over the incision."

A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what?

I will make sure to follow the weight loss plan designed by the dietitian

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what?

I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.

A client is having a "fight or flight response" after receiving bad news about his prognosis. What affect will this have on the client's sympathetic nervous system?

Increase in the secretion of sweat

A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed the patient that alight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria?

Increased fluid intake following the test

A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis.

Infection

An older adult patient sought care for the treatment of a swollen, painful knee joint. Diagnostic imaging and culturing of synovial fluid resulted in a diagnosis of septic arthritis. The nurse should prioritize which of the following aspects of care?

Intravenous administration of antibiotics

A nurse is caring for a client who is postoperative day 1 right hip replacement. How should the nurse position the client?

Keep the client's hips in abduction at all times

A client with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the client's cast care

Keep your right leg elevated above heart level.

A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individual's risk for developing diabetes?

Lose weight, if obese.

The neurologic ICU nurse is admitting a client with increased intracranial pressure. How should the nurse best position the client?

Maintain head of bed elevated at 30-45 degrees

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patient's initial phase of treatment?

Maintaining and monitoring the patients fluid balance

A client is being admitted to the neurologic ICU following an acute head injury that has resulted in cerebral edema. When planning this client's care, the nurse would expect to administer what priority medication?

Mannitol (Osmitrol)

After conducting a preoperative health assessment, the nurse documents that the patient has physical assessments supporting the medical diagnosis of emphysema. Based on this finding, what postoperative interventions would be included on the plan of care?

Monitor respirations and breath sounds

A patient has sustained a long bone fracture and the nurse is preparing the patient's care plan. Which of the following should the nurse include in the care plan?

Monitor temperature and pulses of the affected extremity.

A nurse is assessing a patient who reports a throbbing, burning sensation in the right foot. The patient states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse should recognize the signs and symptoms of what health problem?

Morton's neuroma

A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a nerve injury?

NUMBNESS AND BURNING OF THE FOOT

The nurse is caring for a patient who underwent percutaneous lithrotripsy earlier in the day. What instruction should the nurse give the patient when monitoring for infection?

Notify the physician about cloudy or foul-smelling urine.

A nurse is caring for a client who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the client faces a high risk of what infectious complication?

Osteomyelitis

A patient with diabetes has been diagnosed with osteomyelitis. The nurse notes that the patient's right foot is pale, cool. to the touch, with. a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis?

Osteomyelitis with vascular insufficiency

A patient with a recent history of nephrolithiasis has presented to the ED. After determining the patient's cardiopulmonary status is stable, what aspect of care should the nurse prioritize?

Pain management

A nurse reads that the laboratory report for a patient and notes that the patient has hyponatremia. What physical assessment would be made?

Palpate skin of sternum for edema.

A patient with diabetes is attending a class on the prevention of associated diseases. What action should the patient perform to reduce the risk of osteomuelitis?

Perform meticulous foot care.

A nurse is assessing the neuromuscular status of a client who has had a leg cast recently applied. The nurse is unable to palpate the client's dorsalis pedis or posterior tibial pulse and the client's foot is pale. What is the nurse's most appropriate action?

Promptly inform the primary provider.

The client has been diagnosed with aphasia after suffering a stroke. What can the nurse do to best make the client's atmosphere more conductive to communication?

Provide a board of commonly used needs and phrases.

A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding?

Provide privacy for the patient

A nurse is teaching basic "survival skills" to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address?

Recognition of hypoglycemia and hyperglycemia

A man with urinary incontinence tells the nurse he wears adult diapers for protection. What risks should the nurse discuss with this patient?

Skin breakdown and UTI

The perioperative nurse is constantly assessing the surgical client for signs and symptoms of complications of surgery. Which symptom should first signal to the nurse the possibility that the client is developing malignant hyperthermia?

Tachycardia

The nurse is preparing health education to a client who is being discharged after hospitalization for a hemorrhagic stroke. What content should the nurse include in this education?

Take antihypertensive medication as prescribed.

A client is angry about not being permitted to. smoke and throws the breakfast tray at the nurse. What should the nurse do in response to this outburst?

Tell the client that it is understandable that he is upset, but the no-smoking rule is not negotiable

A. 28 year old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor?

The effects of hormonal changes during pregnancy

An elite high school football player has been diagnosed with a shoulder dislocation. The patient has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education?

The importance of adhering to the prescribed treatment and rehabilitation regimen

A nurse explains the homeostatic mechanisms involved in fluid homeostasis to a student nurse. Which of the following statements accurately describe this process? SATA

The kidneys selectively retain electrolytes and water and excrete wastes and excesses according to the body's needs, the lungs regulate oxygen and carbon dioxide levels of the blood, which is especially crucial in maintaining acid-base balance , the cardiovascular system is responsible for pumping and carrying nutrients and water throughout the body.

The nurse admitting a client who is insulin dependent to the same- day surgical suite for carpal tunnel surgery. How should the client's diagnosis of type 1 diabetes affect the care that the nurse plans?

The nurse should assess the patient's blood glucose levels vigilantly.

A nurse admits a patient who has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal. passages. The orthopedic nurse is aware that this description likely indicates which type of fracture?

The orthopedic nurse is aware that this description likely indicates which type of fracture Compound

The nurse is caring for a client after abdominal surgery in the PACU. The client's blood pressure has increased and the client is restless. The client's oxygen saturation is 97%. What cause for this change in status should the nurse first suspect?

The patient is in pain.

A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding?

The patients insulin levels are inadequate.

A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse should question the patient about what sign or symptom that would suggest the possible development of peripheral neuropathy?

The presence of a tingling sensation

A client diagnosed with transient ischemic attacks (TIAs) is scheduled for a carotid endarterectomy. The nurse explains that this procedure will be done for what purpose?

To remove atherosclerotic plaques blocking cerebral flow

The dressing surrounding a mastectomy client's jackson- pratt drain has scant drainage on it. The nurse believes that the amount of drainage on the dressing may be increasing. How can the nurse best confirm this suspicion?

Trace the outline of the drainage on the dressing for future comparison.

Phosphate is an electrolyte responsible for energy/metabolism and acts as a buffer to maintain homeostasis

True

A diabetic patient calls the clinic complaining of having a "flu bug." The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient?

Try to eat small amounts of carbs, if possible.

A 15 year old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the child's pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes?

Type 1 diabetes

A patient has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication?

What factor may have contributed to this complication Inadequate immobilization

A clinic nurse is conducting a preoperative interview with an adult client who will soon be scheduled to undergo cardiac surgery. What interview question most directly addresses the client's safety?

What prescription and nonprescription medications do you currently take?"

A 25 year old female presents to the ER complaining of burning pain an urgency with urination. She has a fever of 100.1. The urine is strong in odor and cloudy with sediments. What questions should you ask during your assessment to gain more information about the possible causes of the urinary tract infection? SATA

What type of fluids do you drink, tell me more about your normal bathing practices, do you have a history of recurrent urinary tract infections?

One of the things a nurse has taught to a patient during preoperative teaching is to have nothing by mouth for the specified time before surgery. The patient asks the nurse why this is important. What is the most appropriate response for the patient? A. You will need to have food and fluid restricted before surgery so you are not at risk for choking. B. The restriction of food or fluid will prevent the development of pneumonia related to decreased lung capacity. C. The presence of food in the stomach interferes with the absorption of anesthetic agents. D. By withholding food for 8 hours before surgery, you will not develop constipation in the postoperative period.

You will need to have food and fluid restricted before surgery so you are not at risk for choking

A postoperative home care patient has developed thrombophlebitis in her right leg. What category of medications will probably be prescribed for this cardiovascular complication?

anticoagulants

The irreversible loss of all function of the entire brain, including the brainstem is known as _

brain death

A nurse is reviewing the pathophysiology that may underlie a patient's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?

calcitonin

Which ranges of lab values are correct? SATA

calcium 8.5-10.5, sodium 135-145

A patient's PaCO2 is abnormal on an ABG report. Which of the following illnesses would most likely be the medical diagnosis?

chronic obstructive pulmonary disease

The nurse is concerned that an older client with a retention catheter is developing a urinary tract infection. What assessment finding caused this concern?

confusion

A patient exhibits symptoms including fever, flushed skin, restless, dry mouth/skin, confusion, and craving water. As the nurse, you recognize these symptoms as

hypernatremia

A client in the OR goes. into malignant hyperthermia due to an abdominal reaction to the anesthetic. The nurse knows that the area of the brain that regulates body temperature is which of the following?

hypothalamus

You are working on a burn unit and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance?

hypovolemia

A patient has metabolic acidosis. What type of respirations would be assessed?

increasing depth and rate

The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? SATA

medication history, dietary history, family history of renal stones.

Nursing interventions for hypercalcemia would include SATA

mobilizing the patient if possible, restrict calcium carbonate antacids and increase fluid intake

The nurse is caring for a patient diagnosed with hypomagnesemia. The nurse will anticipate care for this patient to include. SATA

monitor cardiac rhythm, monitor DTR'S and if severe, the patient may receive IV magnesium sulfate.

A patient has a decreased potassium level. What high- potassium foods would the nurse teach the patient to eat?

oranges, bananas, brocoli

A client is admitted to the hospital after vomiting for 3 days. Which arterial blood gas results should the nurse expect to find in this client?

ph 7.47,PaCO2 43, HCO3 28

A client is complaining of pain with urination. The nurse realizes that the client needs to be assessed for which health problems? SATA

urethral stricture, bladder injury and urinary infection

During a health history interview, a male patient tells the nurse that he does not feel that he completely empties his bladder when he voids. He has been diagnosed with an enlarged prostate. What is the name of this symptom?

urinary retention


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