Adult Health Exam 3

c. Ammonia A high ammonia level in the blood is a late manifestation of liver failure that results in hepatic coma, causing neurologic dysfunction and brain damage. Sodium, calcium, and potassium levels do not cause hepatic coma.

A high blood level of which substance causes hepatic coma? a. Sodium b. Calcium c. Ammonia d. Potassium

d. NovoSeven NovoSeven is a replacement factor that is beneficial for a patient who has developed inhibitors to factors VIII or IX. Xyntha and alphanate are replacement factors that are beneficial for a patient who has factor VIII deficiency. Mononine is a replacement factor that is beneficial for a patient who has factor IX deficiency.

A patient with hemophilia has developed inhibitors to factors VIII and IX. The nurse recognizes that which replacement factor would be beneficial for the patient? a. Xyntha b. Alphanate c. Mononine d. NovoSeven

b. Violence Violence is defined as the acting out of fear and/or anger to cause harm to someone or something; a bombing is an example of this. Natural disasters and weather may harm people through extremes of wind, temperature, or water. Accidents may involve equipment or trauma to the body, but they are not intentional as in the case of a bomb. While a bomb may emit poisonous substances, it can also be harmful only via explosion.

A bomb explosion is categorized as which type of disaster? a. Natural b. Violence c. Accident d. Poisoning

a. Withhold the blood products and notify the health care provider. Competent adults have the right to make all health care decisions, including the right to refuse treatment based on their religious beliefs. The nurse should withhold the blood products in accordance with the patient's wishes. Contacting the ethics committee is not necessary since the patient's wishes are clear. Since the patient is competent, asking the family for permission to administer blood products would be unethical. Administration of blood products after the patient has confirmed not wanting a transfusion would be unethical.

A competent patient who reports being a Jehovah's Witness is hospitalized with hemorrhage and confirms not wanting to receive blood products. Which action by the nurse is best when the patient becomes unconscious and packed red blood cells are prescribed? a. Withhold the blood products and notify the health care provider. b. Contact the agency's ethics committee about whether to give blood. c. Contact the family for permission to administer blood products to the patient. d. Administer blood products with the intent of informing the patient after the procedure.

b. She should avoid getting pregnant now. Ribavirin may cause severe birth defects. During treatment, women taking the drug and women whose male partners are taking the drug should avoid pregnancy. The pregnancy can be planned after the treatment is complete. She can get pregnant with this partner, but not while on treatment. Avoiding intercourse after conception is not necessary.

A female patient expresses her concern about becoming pregnant while her partner is on ribavirin therapy for chronic hepatitis C. Which recommendation would the nurse provide? a. She can plan pregnancy now. b. She should avoid getting pregnant now. c. She should never get pregnant with this partner. d. She should avoid sexual intercourse after conception.

c. To decrease risk of infection Parenteral nutrition is associated with an increased risk of infection because it must be administered via an IV catheter. Therefore the health care provider opted for nasojejunal tube feeding instead of parenteral nutrition. Parenteral nutrition is given through IV route, thereby ensuring fast absorption. Enteral nutrition involves nasogastric intubation, which is not easier to insert than using parenteral nutrition. When a patient is noncompliant with the treatment plan, high-risk invasive procedures such as parenteral nutrition are not prescribed.

A health care provider orders nasojejunal tube feeding for a patient with acute pancreatitis. Which rationale supports using enteral feeding rather than IV parenteral nutrition? a. To ensure fast absorption b. Because the tube is easier to insert c. To decrease risk of infection d. Because the patient will be more compliant

d. Cardiac dysrhythmias Cardiac dysrhythmias may result because of the increased serum calcium level in hyperparathyroidism. Seizures, cataracts, and dry, scaly skin are complications seen in hypoparathyroidism.

A nurse caring for a patient with hyperparathyroidism would monitor the patient for which complication? a. Seizures b. Cataracts c. Dry, scaly skin d. Cardiac dysrhythmias

c. Small areas of bleeding into the skin d. Vascular lesions formed by small blood vessels e. Small dilated blood vessels with spiderlike branches Ecchymoses are small areas of bleeding into the skin or mucous membrane forming blue or purple patches. Because there is decreased synthesis of prothrombin in the liver, the bleeding and clotting time may be deranged. Telangiectasia is a vascular lesion formed by a group of small blood vessels. Spider angioma is also seen in cirrhosis of the liver. Vitiligo (white patches of skin) develops from destruction of melanocytes and is not related to cirrhosis. Melanosis is the deposit of dark pigment unrelated to cirrhosis.

A nurse is caring for a patient who has cirrhosis of the liver. Which clinical manifestations would the nurse expect to find? Select all that apply. a. White patches on skin b. Deposits of dark pigments c. Small areas of bleeding into the skin d. Vascular lesions formed by small blood vessels e. Small dilated blood vessels with spiderlike branches

a. Blood glucose b. Serum calcium d. Serum magnesium Acute pancreatitis is associated with complications such as hypocalcemia, hypomagnesemia, and increased blood glucose levels. The nurse should monitor calcium levels because reduced levels of calcium result in tetany. The nurse should monitor magnesium levels because a decrease in magnesium levels can lead to fatal complications. Pancreatitis causes damage to β-cells of the pancreas. To assess damage to the β-cells, the nurse should monitor the blood glucose levels of the patient because lack of insulin release can precipitate hyperglycemia. Increased prothrombin time is a manifestation of liver cirrhosis, not pancreatitis. Increased levels of blood urea nitrogen are associated with liver injury and result in hepatic encephalopathy but are not related to pancreatitis.

A nurse is caring for a patient with pancreatitis. Which laboratory results would the nurse plan to monitor? Select all that apply. a. Blood glucose b. Serum calcium c. Prothrombin time d. Serum magnesium e. Blood urea nitrogen

b. Patient B Patients with pancreatic cancer are prescribed anticancer drugs such as fluorouracil, gemcitabine, or erlotinib. However, the nurse has observed tacrolimus in Patient B's chart. Tacrolimus is used as an immunosuppressive drug in patients who underwent liver transplantation. Therefore Patient B's medication chart needs correction. Patients with liver cancer are treated using sorafenib, which inhibits the growth of new blood vessels into tumors in the body, such as Patient A. Fentanyl is an analgesic used to relieve abdominal pain in patients with chronic and acute pancreatitis, such as Patient C. Cyclosporine is a cytotoxic drug effective in the treatment of autoimmune hepatitis for Patient D.

A nurse is preparing medications for a group of patients. Which patient's medication would the nurse question? a. Patient A b. Patient B c. Patient C d. Patient D

b. "I should avoid fiber-rich foods." Fiber-rich foods prevent the risk of constipation in the patient with acute pancreatitis; therefore the patient should consume fiber-rich foods. Patients with pancreatitis should not consume foods rich in fats because fats stimulate the pancreas. Protein-rich foods do not pose any risk to the patient. Foods rich in carbohydrates are least stimulating and can be consumed by the patient.

A nurse is providing dietary instructions to a patient who has pancreatitis. Which statement by the patient indicates the need for further teaching? a. "I should avoid fat-rich foods." b. "I should avoid fiber-rich foods." c. "I should eat protein-rich foods." d. "I should eat carbohydrate-rich foods."

a. Tachycardia b. Heart failure d. Intermittent claudication The compensatory cardiac symptoms of severe anemia are tachycardia, heart failure, and intermittent claudication. The cardiac murmurs that occur in severe anemia are systolic, not diastolic, in nature. In severe anemia, there is an increase in pulse pressure.

A nurse mentor provides teaching to a group of nursing students about the cardiac manifestations of severe anemia. Which compensatory cardiac changes would the nurse include? Select all that apply. a. Tachycardia b. Heart failure c. Diastolic murmurs d. Intermittent claudication e. Decreased pulse pressure

b. Acute pancreatitis Acute pancreatitis is manifested by fever and abdominal pain radiating to the back. Acute pancreatitis may cause absence of bowel sounds and bluish discoloration in the periumbilical region called Grey Turner's spots. Because the child has bluish discoloration adjacent to the navel, abdominal pain, and fever, the nurse suspects the diagnosis to be acute pancreatitis. Pancreatic cysts and abscesses are not characterized by bluish discoloration adjacent to the navel. Chronic pancreatitis is an inflammation of the pancreas that does not heal or improve with medications and is characterized by bluish discoloration adjacent to the navel.

A parent brings a child to a primary health care center and reports that the child has abdominal pain, back pain, and fever. The nurse assesses that the child has diminished bowel sounds and a bluish discoloration adjacent to the navel. Which condition would the nurse suspect? a. Pancreatic cyst b. Acute pancreatitis c. Pancreatic abscess d. Chronic pancreatitis

c. Stabilize the patient and manage the airway. Individuals with cirrhosis of the liver are at risk of bleeding from esophageal and gastric varices. Hematemesis in the patient with cirrhosis of the liver is likely to be variceal bleeding. In this case, the nurse should first stabilize the patient and manage the airway. Once the patient is stable, other steps in treatment can be initiated, such as assessing further and administering necessary medications. Shunting procedures may be planned after a repeated major bleeding episode.

A patient admitted to the hospital with cirrhosis of the liver suddenly vomits blood. Which action would the nurse take? a. Give propranolol orally. b. Check for signs of ascites. c. Stabilize the patient and manage the airway. d. Prepare the patient for a shunting procedure.

a. Assessing the patient's weight b. Positioning the head of the bed flat c. Restricting fluid intake to 900 mL/day Assessing the patient's weight after the initiation of fluid restriction would give the nurse information about gradual weight reduction because fluid restriction results in the weight reduction and a progressive rise in serum sodium concentration, osmolality, and symptomatic improvement. Positioning the head of the patient's bed flat enhances venous return to the heart and increases left atrial filling pressure, thereby reducing the release of antidiuretic hormone. When the patient's serum sodium levels are at or above 125 mEq/L, fluid intake should be restricted to 800 to 1000 mL/day to prevent severe symptoms. Opioid drugs are contraindicated in patients with SIADH because they stimulate the release antidiuretic hormone (ADH). Administration of IV hypertonic solution is not required when the symptoms are mild.

A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium level of 130 mEq/L and complains of a severe backache. Which nursing interventions would be included in the plan of care? Select all that apply. a. Assessing the patient's weight b. Positioning the head of the bed flat c. Restricting fluid intake to 900 mL/day d. Administering opioid analgesics for the management of pain e. Administering IV hypertonic solution for the management of sodium levels

d. Accelerated platelet destruction Ingestion of drugs may cause accelerated platelet destruction due to drug-dependent antibodies. Altered platelet aggregation is the cause of thrombotic thrombocytopenic purpura (TTP). Adequate platelet production will not cause thrombocytopenia in the patient. Decreased platelet production contributes to idiopathic thrombocytopenic purpura.

A patient experiences thrombocytopenia due to consumption of certain drugs. The nurse suspects that which mechanism of thrombocytopenia occurred? a. Altered platelet aggregation b. Adequate platelet production c. Decreased platelet production d. Accelerated platelet destruction

a. Mild anemia In mild anemia, hemoglobin is in the range of 10-12 g/dL. In severe anemia, it is less than 6 g/dL. Aplastic anemia refers to a type of anemia caused by a decrease in red blood cell precursors. It does not refer to the severity of anemia. In moderate anemia, the hemoglobin it is in the range of 6-10 g/dL. Hemoglobin above 12 g/dL is considered normal (no anemia).

A patient has a hemoglobin level of 11 g/dL. The nurse determines that the patient has which level of severity of anemia? a. Mild anemia b. Severe anemia c. Aplastic anemia d. Moderate anemia

a. Jaundice b. Steatorrhea d. Dark-amber urine e. Bleeding tendencies Manifestations of obstructed bile flow in a patient with cholelithiasis include jaundice, dark-amber urine that foams when shaken, clay-colored (not dark, tarry) stools, pruritus, intolerance for fatty foods (nausea, sensation of fullness, anorexia), bleeding tendencies, and steatorrhea. Dark, tarry stools are not a manifestation of obstructed bile flow; clay stools are.

A patient has been diagnosed with cholelithiasis. Which findings would indicate possible obstructed bile flow? Select all that apply. a. Jaundice b. Steatorrhea c. Dark, tarry stools d. Dark-amber urine e. Bleeding tendencies

a. Restrict all oral intake of food. Sudden and severe pain in the left upper quadrant of the abdomen and radiating to the back indicates acute pancreatitis. Initially, it is very important to avoid giving anything by mouth to a patient with pancreatitis to reduce pancreatic secretions. Eventually, when food is allowed, small, bland, frequent feedings are given. The diet is usually high in carbohydrates and low in fat because that is the least stimulating to the exocrine portion of the pancreas. Eventually, the patient should avoid foods that aggravate the pain.

A patient has sudden and severe pain in the left upper quadrant of the abdomen and radiating to the back. The pain is aggravated by eating and is not relieved by vomiting. Which intervention would the nurse include in the initial plan of care? a. Restrict all oral intake of food. b. Give small, frequent oral feedings. c. Identify foods that aggravate the pain. d. Instruct to avoid spicy and high-fat food.

a. Jaundice c. Exocrine function e. Pancreatic necrosis Jaundice may be associated with severe pancreatitis. Patients with severe pancreatitis have diminished exocrine and endocrine function and necrosis of the pancreas. Spider angiomas, as well as cirrhosis of the liver, are associated with long-term corticosteroid use. Thrombocytopenia, or decreased platelets, is not associated with severe pancreatitis.

A patient is admitted with severe acute pancreatitis. Which clinical manifestations would the nurse expect? Select all that apply. a. Jaundice b. Spider angiomas c. Exocrine function d. Thrombocytopenia e. Pancreatic necrosis

a. The gallbladder is removed through one to four small punctures on the abdominal wall. b. The procedure is done under anesthesia, using a laparoscope and grasping forceps. e. The patient can be discharged on the day of operation or the next day and resume work in a week. Laparoscopic cholecystectomy involves making one to four punctures on the abdominal wall, and the gall bladder is removed using laparoscope and grasping forceps. This procedure is done under anesthesia. The patient can be discharged in a day or two because the recovery is fast. This procedure does not involve an abdominal incision. A T-tube may be left in place after an open cholecystectomy but is not used after a laparoscopic cholecystectomy.

A patient is advised to undergo laparoscopic cholecystectomy. The patient asks the nurse what exactly this procedure means. Which points will the nurse include in an explanation? Select all that apply. a. The gallbladder is removed through one to four small punctures on the abdominal wall. b. The procedure is done under anesthesia, using a laparoscope and grasping forceps. c. The gallbladder is removed through an incision made on the right subcostal region. d. A tube will be inserted during surgery and will be left in place to drain bile fluids. e. The patient can be discharged on the day of operation or the next day and resume work in a week.

a. Fatigue b. Pruritus c. Anorexia The acute phase of hepatitis usually lasts from one to four months. During the incubation period, symptoms may include malaise, anorexia and weight loss, fatigue, nausea, occasional vomiting, and abdominal (right upper quadrant) discomfort. The patient may find food repugnant, and smokers may have distaste for cigarettes. There is also a decreased sense of smell. Other symptoms may include headache, low-grade fever, arthralgias, and skin rashes. Pruritus (intense chronic itching) sometimes accompanies jaundice. The pruritus occurs as a result of the accumulation of bile salts beneath the skin. Dizziness and visual disturbances are not symptoms of the acute phase of hepatitis A.

A patient is in the acute phase of hepatitis A. Which symptoms is the patient likely to be experiencing? Select all that apply. a. Fatigue b. Pruritus c. Anorexia d. Dizziness e. Visual disturbances

c. "It will evaluate the severity of chronic pancreatitis." The secretin stimulation test is performed in patients with chronic pancreatitis to determine the degree of pancreatic function. A diagnosis of diabetes mellitus is determined by blood glucose levels in the body, not by the secretin stimulation test. Acute pancreatitis is diagnosed by a contrast-enhanced CT scan and amylase levels. A test to check serum ceruloplasmin level is ordered in patients with Wilson's disease.

A patient is scheduled for a secretin stimulation test and asks the nurse what this will evaluate. What is the best response by the nurse? a. "It will determine whether you have diabetes mellitus." b. "It will determine if you have acute pancreatitis." c. "It will evaluate the severity of chronic pancreatitis." d. "It will evaluate whether you are at risk for Wilson's disease."

d. Hydrocodone with acetaminophen The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and is likely to have impaired liver function. Acetaminophen is not suitable for this patient because it is converted to a toxic metabolite in the liver after absorption, increasing the risk for hepatocellular damage. Tramadol, hydromorphone, and oxycodone with aspirin are less likely to cause complications than acetaminophen.

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged after knee surgery. Which medication prescription would the nurse question? a. Tramadol b. Hydromorphone c. Oxycodone with aspirin d. Hydrocodone with acetaminophen

d. Avoid straining during defecation to keep venous pressure low. Straining during a bowel movement increases venous pressure and could cause rupture of the varices. Fluid restrictions are not required with esophageal varices. If the patient is able to eat, meals should be soft or liquid, and the patient should be instructed to eat slowly and avoid extremes in food temperature to prevent irritation. Excessive exercise and activity should be avoided in a patient with esophageal varices to prevent hypertension; however, avoiding straining and other activities that cause the Valsalva maneuver is still a higher-priority recommendation.

A patient is stable after treatment of recently diagnosed esophageal varices. Which information would the nurse include in the teaching plan for this patient? a. Decrease fluid intake to avoid irritating the varices. b. Eat foods quickly so they do not get cold and cause distress. c. Avoid exercise because it may cause bleeding of the varices. d. Avoid straining during defecation to keep venous pressure low.

b. Four tablets Using ratio and proportion, multiply 250 by x and multiply 1000 × 1 to yield 250x = 1000. Divide 1000 by 250 to yield four tablets.

A patient is to receive cobalamin (vitamin B ) 1,000 mcg by mouth (PO). The pharmacy issues 250-mcg tablets. Which number of tablets would the nurse administer to the patient? a. Two tablets b. Four tablets c. Six tablets d. Eight tablets

b. Obtain laboratory tests. c. Assess the patient's pain. d. Insert a nasogastric tube. e. Monitor the patient's electrocardiogram (ECG) rhythm. f. Continuously monitor the oxygen saturation level. The resuscitation adjunct measures implemented in the monitoring of a patient's condition during the primary survey include obtaining laboratory testing, assessing the patient's pain, inserting a nasogastric tube, monitoring the patient's ECG rhythm, and continuous monitoring of the oxygen saturation rate. Inspection of the chest is included in the secondary survey.

A patient presents to the emergency department with a life-threatening illness. When monitoring the patient's condition during the primary survey, the nurse performs which resuscitation adjunct measures? Select all that apply. a. Inspect the chest. b. Obtain laboratory tests. c. Assess the patient's pain. d. Insert a nasogastric tube. e. Monitor the patient's electrocardiogram (ECG) rhythm. f. Continuously monitor the oxygen saturation level.

d. Hepatocellular jaundice Hepatocellular jaundice is associated with increased serum levels of both conjugated and unconjugated bilirubin and increased levels of urinary bilirubin. Fatigue, yellowing of the eyes, nausea, and vomiting are the clinical manifestations of hepatocellular jaundice. Urinary bilirubin levels are elevated in patients with acute hepatitis, but levels of serum bilirubin remain the same. Chronic hepatitis is associated with increased levels of serum alkaline aminotransferase (ALT) and aspartate aminotransferase (AST). In hemolytic jaundice, conjugated bilirubin levels are normal, urinary bilirubin levels are negative, and serum unconjugated bilirubin levels are elevated.

A patient presents with fatigue, nausea, vomiting, and yellowish-colored eyes. Laboratory test results reveal increased serum levels of both conjugated and unconjugated bilirubin and increased levels of bilirubin in the urine. Which condition is consistent with these findings? a. Acute hepatitis b. Chronic hepatitis c. Hemolytic jaundice d. Hepatocellular jaundice

d. Chronic pancreatitis The symptoms of chronic pancreatitis include nausea, vomiting, fever, jaundice with dark urine, and steatorrhea. Jaundice presents with clinical reports of hyperbilirubinemia, which is increased levels of bilirubin in blood. Steatorrhea is associated with foul-smelling, fatty stools. Because the patient's laboratory reports reveal all of the above findings, the nurse suspects the patient to have chronic pancreatitis. Symptoms of liver cancer include nausea, vomiting, and jaundice, and the laboratory findings show elevated levels of serum alpha-fetoprotein. Acute liver failure is manifested by jaundice and coagulation abnormalities. Patients with acute liver failure have increased serum levels of bilirubin and prolonged prothrombin time. Acute pancreatitis is manifested by nausea, vomiting, and abdominal pain; the laboratory tests reveal increased serum amylase and lipase levels.

A patient reports abdominal pain and nausea. The nurse observes a temperature of 99°F (37.2°C), vomiting, dark urine, and foul-smelling stool. The laboratory reports reveal increased levels of bilirubin in the blood. Which condition would the nurse suspect? a. Liver cancer b. Acute liver failure c. Acute pancreatitis d. Chronic pancreatitis

b. Meningitis A hypophysectomy is usually performed through the sphenoid sinuses, and the health care provider packs the sphenoid sinus with gauze. When a specimen is tested for a cerebrospinal fluid (CSF) leak, a glucose level greater than 30 mg/dL indicates a CSF leak from an open connection with the brain. If this happens, then the patient has an increased risk for meningitis. Diabetes is not a complication of a CSF leak from hypophysectomy. Hypoglycemia is not a complication of a CSF leak from hypophysectomy. Visual deterioration after hypophysectomy would be evidenced by changes in extraocular movements, peripheral vision changes, and changes in visual acuity.

A patient status post a hypophysectomy had drainage on the moustache dressing. Which complication is this patient at risk for if the glucose level of the drainage is 50 mg/dL? a. Diabetes b. Meningitis c. Hypoglycemia d. Visual deterioration

c. Pancreatitis Pancreatitis is manifested by abdominal pain, nausea, leukocytosis, and low-grade fever. The normal range of WBC and body temperature is 4,500 to 10,000/μL and 98.6°F (37°C), respectively. The patient has abnormal levels of WBC and an elevated body temperature. The circulating trypsin in pancreatitis causes bluish discoloration of the flanks (the area between the last rib and the hip), called Grey Turner's sign, a characteristic of acute pancreatitis. Therefore the patient may have pancreatitis. Jaundice, peripheral edema, and skin lesions such as spider angioma are manifestations of cirrhosis. Liver failure is manifested by jaundice, coagulation abnormalities, and encephalopathy. Jaundice, fever, and abdominal pain are characteristics of cholecystitis. Though increased WBC count is seen in cholecystitis, bluish discoloration is not seen.

A patient reports nausea and abdominal pain. The nurse notices bluish discoloration in the area between the patient's last rib and the hip and records a body temperature of 99.1°F (37.3°C). The laboratory reports reveal a white blood cell count (WBC) of 12,000 cells/µL. Which condition would the nurse suspect in this patient? a. Cirrhosis b. Liver failure c. Pancreatitis d. Cholecystitis

c. Pancreatitis Pancreatitis is manifested by abdominal pain, nausea, vomiting, jaundice, leukocytosis, increased erythrocyte sedimentation rate, and elevated levels of serum alkaline phosphatase. The normal WBC count, bilirubin, and alkaline phosphatase are 4,500 to 10,000 cells/-µL, 0.3 to 1.9 mg/dL, and 25 to 100 U/L, respectively. The patient's findings reveal leukocytosis, an increased erythrocyte sedimentation rate, and an elevated serum alkaline phosphatase. Therefore the nurse suspects that the patient has chronic pancreatitis. Cirrhosis is associated with decreased serum albumin and increased serum globulin, bilirubin, and prolonged prothrombin time. Liver enzymes and serum amylase are elevated in the patient with gallstones. Liver cancer is associated with increased serum bilirubin and alpha-fetoprotein.

A patient reports nausea, vomiting, and abdominal tenderness. The patient's laboratory reports reveal an erythrocyte sedimentation rate of 32 mm/hr, a white blood cell (WBC) count of 12,000/-µL, 2.2 mg/dL of bilirubin, and serum alkaline phosphatase of 120 U/L. Which condition would the nurse suspect? a. Cirrhosis b. Gallstones c. Pancreatitis d. Liver cancer

d. Pancreatic abscess A normal count of WBC is 4500 to 10,000 cells/µL. The laboratory reports reveal an increased WBC count, which indicates that the patient has leukocytosis. Abdominal mass, abdominal pain, nausea, vomiting, and leukocytosis are manifestations of pancreatic abscess. Therefore the health care provider suspects that the patient has pancreatic abscess. Though pseudocysts have the same manifestations as those of pancreatic abscess, the laboratory findings of pseudocysts include elevated serum amylase rather than increased WBC. Cullen's sign is manifested by discoloration of the abdominal wall and the periumbilical region. Spider angioma is a manifestation of liver cirrhosis, wherein the patient has a dilated blood vessel with a red center that branches like a spider web.

A patient reports severe abdominal pain, nausea, and vomiting. The nurse palpates a mass in a patient's upper abdomen. Laboratory reports show the white blood cell (WBC) count as 12,000 cells/µL. The nurse would anticipate that the patient will be treated for which condition? a. Pseudocyst b. Cullen's sign c. Spider angioma d. Pancreatic abscess

d. Acute pancreatitis Acute pancreatitis is manifested by abdominal pain, low-grade fever, tachycardia, leukocytosis, and elevated amylase and lipase values. A normal WBC count is 4,000 to 11,000/-µL, a normal lipase range is 0 to 160 U/L, and a normal amylase range is 30 to 122U/L. The patient's laboratory values of WBC at 13,000/-µL, lipase at 180 U/L, and amylase at 150 U/L indicate leukocytosis and high lipase and amylase levels. Nausea, vomiting, arthralgias, and jaundice are manifestations of hepatitis. Cholelithiasis is manifested by pain, fever, and jaundice. Liver cirrhosis is manifested by skin lesions, leukopenia, and endocrine problems, such as gynecomastia in men or amenorrhea in women.

A patient reports severe pain in the abdomen. The patient's body temperature is 100°F (37.7°C). The laboratory reports show a white blood cell (WBC) count of 13,000/µL, lipase of 180 U/L, and amylase of 150 U/L. Which condition would the nurse suspect? a. Hepatitis b. Cholelithiasis c. Liver cirrhosis d. Acute pancreatitis

d. Acute pancreatitis The nurse suspects acute pancreatitis based on the subjective symptoms of severe piercing abdominal pain, shortness of breath, and the objective symptoms of elevated serum amylase, triglycerides, and lipase levels as well as hyperglycemia. Hypoalbuminemia and hypokalemia are the characteristics of cirrhosis. Cholecystitis is associated with increased serum levels of liver enzymes such as alkaline phosphatase, aspartate aminotransferase, and alanine transferase. Serum α-fetoprotein (AFP) levels would be elevated in hepatocellular cancer.

A patient reports severe, piercing pain in the abdomen, accompanied by shortness of breath. The laboratory reports demonstrate elevated serum amylase, triglycerides, and lipase levels, as well as hyperglycemia. Which condition would the nurse suspect? a. Cirrhosis b. Cholecystitis c. Hepatic cancer d. Acute pancreatitis

b. Prolactinomas Prolactinomas are among the most common type of pituitary adenomas; compression of the chiasm nerve is a complication of this condition and can cause visual problems with signs of increased intracranial pressure, including headache, nausea, and vomiting. Patients with acromegaly, diabetes insipidus, and panhypopituitarism are not associated with the complication of a compressed optic chiasm.

A patient reports to the nurse having visual problems and is found to have a compressed optic chiasm. Which condition could be the reason for this complication? a. Acromegaly b. Prolactinomas c. Diabetes insipidus d. Panhypopituitarism

b. Obesity increases the risk, especially in women. Obesity causes increased secretion of cholesterol in bile, increasing the prevalence of cholelithiasis. Pregnancy is a high-risk factor for cholelithiasis, and multiparous women have the greatest risk of all. Cholelithiasis is more common in women than in men. Gender differences in the incidence of cholelithiasis decrease after 50 years of age.

A patient returns to the surgical center for his postoperative visit 10 days after a cholecystectomy. The patient's wife asks whether she should be concerned about having cholelithiasis as well. Which information about risk factors would the nurse consider in providing a response? a. Pregnancy is not a risk factor for cholelithiasis. b. Obesity increases the risk, especially in women. c. The incidence of cholelithiasis is lower in women than in men. d. Gender differences in the incidence decrease after 30 years of age.

d. Extracorporeal shock-wave lithotripsy (ESWL) ESWL is a procedure involving the use of high-energy shock waves to disintegrate gallstones. This method is used when endoscopic procedures cannot be used to remove the stones. Cholecystojejunostomy is surgical removal of the gallbladder. Pancreaticoduodenectomy is the surgical formation of a means of communication between the gallbladder and jejunum. Balloon sphincteroplasty is an adjunct procedure used with extracorporeal shock-wave lithotripsy to dilate the biliary duct.

A patient tells the nurse, "Gallstones were removed by passing shock waves into my gallbladder." Which procedure is the patient referring to? a. Cholecystojejunostomy b. Pancreaticoduodenectomy c. Balloon sphincteroplasty d. Extracorporeal shock-wave lithotripsy (ESWL)

a. Fainting b. Dizziness e. Abdominal pain A patient with thrombocytopenia will experience fainting, dizziness, and abdominal pain because of prolonged bleeding. A patient with thrombocytopenia will have tachycardia and hypotension because of decreased quantity of blood.

A patient that experiences prolonged bleeding is diagnosed with thrombocytopenia. The nurse expects which assessment findings? Select all that apply. a. Fainting b. Dizziness c. Bradycardia d. Hypertension e. Abdominal pain

a. Avoid high-fat foods. b. Eat a diet high in proteins. c. Consume a high-calorie diet. Having a low-fat, high-protein, and high-carbohydrate diet is essential. The diet should be low in fat to decrease the workload of the liver and promote healing. A highcalorie diet should be provided because more energy is required. High-calorie meals are needed for energy and to promote the use of protein for tissue repair. A highprotein diet is required for tissue building. The diet should be high in carbohydrates to provide the required energy. The patient should not resume a normal diet and should follow the restrictions as advised.

A patient underwent pancreaticoduodenectomy (Whipple procedure) for pancreatic cancer. Which dietary instructions would the nurse give to this patient? Select all that apply. a. Avoid high-fat foods. b. Eat a diet high in proteins. c. Consume a high-calorie diet. d. Consume a low-carbohydrate diet. e. Resume normal diet without any restrictions.

d. Administering thyroid hormone IV e. Monitoring cardiovascular status continuously The patient with long-standing hypothyroidism exhibiting mental deterioration and a very low body temperature is suspected to be experiencing myxedema coma, which is a medical emergency. Appropriate interventions include administering thyroid hormone IV and continuous monitoring of cardiovascular status. Radiotherapy is not performed in an emergency. A low-pressure mattress is used to decrease the risk for skin breakdown. Mechanical ventilation, not oxygen therapy, is expected for this patient.

A patient who has 20-year history of hypothyroidism was admitted to the intensive care unit (ICU) with a decreased level of consciousness and a temperature of 96° F. Which interventions would be included in the plan of care for this patient? Select all that apply. a. Performing radiotherapy b. Using a high-pressure mattress c. Providing oxygen therapy d. Administering thyroid hormone IV e. Monitoring cardiovascular status continuously

b. Repeat complete blood count d. Hydromorphone 2 mg IV every six hours PRN for pain e. Ondansetron 4 mg IV every six hours for nausea and vomiting Conservative management for acute cholecystitis focuses on symptom management and observation for complications. A complete blood count monitors the white blood cell count; if elevated, this could signal infection. Patients with acute cholecystitis frequently have pain and may be treated with an IV opioid such as hydromorphone, and nausea and vomiting are other common symptoms that are frequently relieved with antiemetics. A regular diet is not indicated. These patients are initially required to fast and then progress to clear liquids. Insertion of a nasogastric tube may be indicated if the patient's condition worsens or if nausea and vomiting persist after the administration of antiemetics.

A patient who has acute cholecystitis is fearful of undergoing surgery and wants to try conservative management. Which prescriptions would the nurse expect to see entered in the patient record? Select all that apply. a. A regular diet b. Repeat complete blood count c. Immediate insertion of a nasogastric tube d. Hydromorphone 2 mg IV every six hours PRN for pain e. Ondansetron 4 mg IV every six hours for nausea and vomiting

d. Void urine immediately before the procedure. The nurse should instruct the patient to void prior to the paracentesis to prevent accidental puncture of the bladder. There is no need to keep the patient on NPO status or to restrict fluid intake. The patient should not hold the urine because that increases the risk for bladder puncture.

A patient who has cirrhosis of the liver with ascites is being prepared for a paracentesis. Which instructions would the nurse give the patient? a. Do not pass urine until after the procedure. b. Do not take any fluids before the procedure. c. Fast overnight the night before the procedure. d. Void urine immediately before the procedure.

a. Encourage the patient to cough. b. Reposition the patient frequently. e. Administer cough suppressants to prevent coughing. The patient who has had a liver transplant requires highly skilled nursing care in an ICU or another specialized unit. To prevent respiratory complications, the patient should be encouraged to use measures such as coughing, deep breathing, and repositioning. Administering cough suppressants would be counterproductive to recovery. The patient will be ambulated later, when the condition is stable.

A patient who has just undergone a liver transplant is transferred to the intensive care unit (ICU). Which interventions would the nurse plan to prevent respiratory complications? Select all that apply. a. Encourage the patient to cough. b. Reposition the patient frequently. c. Instruct the patient to walk around the bed. d. Encourage the patient to take deep breaths. e. Administer cough suppressants to prevent coughing.

d. Choledochojejunostomy When a patient with chronic pancreatitis is diagnosed with a biliary tract disease, surgery is required to treat the condition. The surgery involves diversion of bile flow and relieving the duct from obstruction. In patients with chronic pancreatitis, choledochojejunostomy is performed to divert bile flow around the ampulla of Vater. Therefore the nurse anticipates that choledochojejunostomy will be beneficial to the patient. Cholecystectomy is performed in patients with gallbladder disease. A Whipple procedure is the treatment option for patients with pancreatic cancer. Chemoembolization is performed in patients with liver cancer.

A patient who has severe abdominal pain is diagnosed with chronic pancreatitis secondary to cholecystitis. Which treatment option would the nurse anticipate will be planned? a. Cholecystectomy b. Whipple procedure c. Chemoembolization d. Choledochojejunostomy

d. Protamine sulfate Protamine sulfate reverses the anticoagulant effects of circulating heparin during severe clotting. Lepirudin is given to maintain anticoagulation. Rituximab is given to reduce the immune recognition of platelets. Prednisone is used to suppress the phagocytic response of splenic macrophages.

A patient who is receiving heparin therapy manifests signs of heparin overdose. Which medication would the nurse anticipate administering? a. Lepirudin b. Rituximab c. Prednisone d. Protamine sulfate

c. Performing gastric decompression Gastric decompression is performed to remove the gastric contents via a nasogastric tube to prevent aspiration of food contents and reduce the incidence of nausea and vomiting. Lactulose is a laxative and is used to treat constipation. Rifaximin is an antibiotic prescribed for patients with hepatic encephalopathy. Endotracheal intubation is a means of providing ventilation to the patient.

A patient who is receiving treatment for cholelithiasis experiences severe nausea and six episodes of vomiting. Which intervention would the nurse plan for the patient? a. Administering lactulose b. Administering rifaximin c. Performing gastric decompression d. Performing endotracheal intubation

a. Apply 100% oxygen. The initial intervention for a patient with carbon monoxide poisoning is to apply 100% oxygen via a face rebreather mask. Pulse oximetry does not measure carbon dioxide. Obtaining arterial blood gases is not a priority. There is no indication the patient requires intubation.

A patient who was exposed to carbon monoxide poisoning tells the nurse, "I can't remember what happened." Which initial action does the nurse take? a. Apply 100% oxygen. b. Implement pulse oximetry. c. Obtain arterial blood gases. d. Prepare the patient for intubation.

c. Hepatocellular cancer The nurse suspects that the patient has hepatocellular cancer. Abdominal pain, jaundice, nausea, and vomiting are the clinical manifestations of hepatocellular cancer, and an elevated level of serum α-fetoprotein is used as a marker for liver cancer. Patients with cirrhosis have elevated levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Jaundice, encephalopathy, and coagulation abnormalities are the clinical manifestations of acute liver failure. Hepatic encephalopathy causes impaired consciousness and changes in neurologic and mental behavior. Patients with hepatic encephalopathy have increased levels of ammonia in their blood.

A patient with a history of alcohol abuse reports dull abdominal pain, yellowing eyes, nausea, and vomiting for three weeks. The laboratory report reveals that the patient has elevated serum levels of the liver enzymes and an increased level of serum α-fetoprotein. Which condition would the nurse suspect? a. Liver cirrhosis b. Acute liver failure c. Hepatocellular cancer d. Hepatic encephalopathy

b. Bruising e. Petechiae A low platelet count, known as thrombocytopenia, may be accompanied by signs of hemorrhage, such as bruising and petechiae. A normal platelet count is 150,000 to 400,000/mm3. Weakness, dizziness, and vomiting are not directly associated with thrombocytopenia.

A patient with a platelet count of 52,000/mm3 is diagnosed with thrombocytopenia. The nurse would expect which clinical manifestations? Select all that apply. a. Weakness b. Bruising c. Dizziness d. Vomiting e. Petechiae

a. Jaundice results from the body's inability to conjugate and excrete bilirubin. Jaundice results from the functional derangement of liver cells and compression of bile ducts by connective tissue overgrowth. Jaundice occurs as a result of the decreased ability to conjugate and excrete bilirubin. Jaundice is not caused by a lack of clotting factors, an excess of bile salts, or decreased colloidal oncotic pressure.

A patient with advanced cirrhosis asks why the skin is so yellow. Which information would the nurse use to provide a response? a. Jaundice results from the body's inability to conjugate and excrete bilirubin. b. A lack of clotting factors promotes the collection of blood under the skin surface. c. Decreased peristalsis in the gastrointestinal tract contributes to an excess of bile salts. d. Decreased colloidal oncotic pressure from hypoalbuminemia causes the skin discoloration.

b. Assist the patient in prioritizing activities. The nurse should teach and assist the patient and caregiver to assign priority to activities to accommodate energy levels and promote tolerance for important activities. The caregiver should limit the number of visitors so that the patient receives adequate rest. The patient should be asked to avoid activity immediately after meals to reduce competition for oxygen supply to vital functions. Activities should be alternated with rest periods throughout the day rather than completed in the morning.

A patient with anemia experiences fatigue when performing activities of daily living. Which nursing intervention is appropriate to include in the patient's plan of care? a. Encourage frequent visitors. b. Assist the patient in prioritizing activities. c. Assist the patient in walking immediately after meals. d. Ensure that all physical activities are completed in the morning.

a. Clay-colored stools b. Skin itching and irritation e. Extreme upper abdominal pain that radiates to the back Tumor of the head of the pancreas will obstruct the common bile duct where it passes through the head of the pancreas to join the pancreatic duct and empty at the ampulla of Vater into the duodenum. The stools will be clay-colored when bile is not able to enter the duodenum. Pruritus is also a common symptom in cancer of the pancreas; hence the patient may complain of itching and irritation of the skin. Severe pain is also present. The pain generally depends on the part affected and severity. Edema and ulcers are not common manifestations of pancreatic cancer.

A patient with cancer of the head of the pancreas is admitted to the hospital. Which manifestations would the nurse expect in this patient? Select all that apply. a. Clay-colored stools b. Skin itching and irritation c. Facial and extremity swelling d. Ulcers on the back and abdomen e. Extreme upper abdominal pain that radiates to the back

d. Mix the medication with four to six ounces of milk. Cholestyramine is an antihistamine that effectively treats pruritus. The powdered form of cholestyramine should be mixed with four to six ounces of milk to ensure adequate absorption. Cholestyramine can be taken along with fruit juices and water. The powdered form of cholestyramine medication should be taken by mixing with milk or juice, not directly from the container.

A patient with cholecystitis receives a prescription for cholestyramine in powdered form. Which medication instruction would the nurse provide? a. Avoid mixing the medication with water. b. Avoid taking the medication with fruit juice. c. Take the medication directly in powdered form. d. Mix the medication with four to six ounces of milk.

d. Cholestyramine Bilirubin levels in a healthy individual are between 0.3 and 1.9 mg/dL. The patient's laboratory reports indicate hyperbilirubinemia, which results in jaundice. Moreover, the patient has severe itching, or pruritus. Pruritus that is accompanied by jaundice is treated with cholestyramine. Nadolol is a β-blocker used for patients with cirrhosis to reduce bleeding from varices. Lactulose is used for relieving constipation. Vasopressin is a vasoconstrictor drug that controls bleeding from the varices and maintains hemostasis.

A patient with cholelithiasis is experiencing severe itching. Laboratory findings reveal a 2.1 mg/dL bilirubin level. Which medication is likely to be prescribed? a. Nadolol b. Lactulose c. Vasopressin d. Cholestyramine

b. Pack the joint in ice. c. Provide analgesics such as acetaminophen. e. Encourage the patient to perform range-of-motion exercises when bleeding is stopped. Factor VIII deficiency leads to hemophilia, which is a severe bleeding disorder. When joint bleeding occurs, the joint should be packed in ice to reduce bleeding. Analgesics such as acetaminophen should be provided to reduce pain. When bleeding is stopped, the patient should be encouraged to perform range-of-motion exercises to increase mobilization. Aspirin should be avoided because it may increase bleeding. Weight-bearing activity should be performed when the swelling has decreased and muscle strength has returned.

A patient with factor VIII deficiency experiences joint bleeding. Which interventions would be included in the patient's plan of care? Select all that apply. a. Administer aspirin. b. Pack the joint in ice. c. Provide analgesics such as acetaminophen. d. Encourage the patient to perform weight-bearing activity to increase muscle strength. e. Encourage the patient to perform range-of-motion exercises when bleeding is stopped.

a. Monitor vital signs. c. Perform gastric decompression. d. Place the patient on a low-fat diet. The nurse should monitor for the patient's vital signs to reduce the risk of any complications. It may be necessary to insert a nasogastric tube and use gastric decompression for patients with severe nausea and vomiting. For patients with less severe nausea and vomiting, antiemetics are usually adequate. Because the patient is vomiting frequently, the nurse should rinse the patient's mouth every two hours to provide comfort. Consuming fat may stimulate the gallbladder; the patient should be placed on a low-fat diet.

A patient with gallbladder disease has frequent episodes of severe vomiting. Which interventions would the nurse include in the patient's plan of care? Select all that apply. a. Monitor vital signs. b. Rinse the mouth daily. c. Perform gastric decompression. d. Place the patient on a low-fat diet. e. Administer prescribed antiemetics.

c. Tranexamic acid Tranexamic acid is an antifibrinolytic drug, which inhibits fibrinolysis by inhibiting plasminogen activation in the fibrin clot, thereby enhancing clot stability. It helps stabilize clots in patients with difficult episodes of epistaxis and menorrhagia. Danazol is an androgen, which is used along with corticosteroids in some patients with immune thrombocytopenic purpura (ITP). Cyclosporine is used to suppress the immune system in patients with ITP. Protamine sulfate reverses the effects of heparin and is used in the treatment of heparin-induced thrombocytopenia (HIT).

A patient with hemophilia experiences difficult episodes of epistaxis and menorrhagia. Which drug would the nurse expect to incorporate into the plan of care? a. Danazol b. Cyclosporine c. Tranexamic acid d. Protamine sulfate

d. Fecal contamination of food or water Hepatitis A is primarily transmitted through ingestion of organisms on fecal-contaminated hands, food, or water. Care should be taken in the handling of food and water, as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment, such as gloves, are important in preventing the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important in decreasing the risk of transmission. Sexual intercourse, contact with infected blood, and contact through mucous membranes all present higher risk for hepatitis B and C than for hepatitis A.

A patient with hepatitis A asks whether other family members are at risk for "catching " the disease. Which information about the primary method of hepatitis A transmission would the nurse include in the response? a. Sexual intercourse b. Kissing mouth to mouth c. Contact with infected blood d. Fecal contamination of food or water

c. Wash hands carefully after bowel movements. The mode of transmission of hepatitis A infection is the fecal-oral route. Therefore it is very important to maintain personal and environmental hygiene. The nurse should teach the patient and the family members about careful hand washing immediately after bowel movements and before eating to prevent outbreaks of hepatitis A viral infection. Not sharing toothbrushes and razors is a concern for the prevention of hepatitis B and C because they are transferred through blood contact. There is no need to isolate the patient with hepatitis A unless he or she is incontinent or maintains poor personal hygiene. Acetaminophen may cause liver damage and should be avoided in hepatic viral infection.

A patient with hepatitis A infection is being discharged from the hospital. Which instruction would the nurse include in the discharge teaching? a. Do not share razors or toothbrushes. b. Isolate yourself from other family members. c. Wash hands carefully after bowel movements. d. Take acetaminophen every four hours if fever persists.

c. Reduced capillary leakage d. Depressed antibody formation Corticosteroids reduce capillary leakage by altering capillary permeability. Corticosteroids also depress antibody formation by decreasing immunoglobulin synthesis and by lympholytic action. Rituximab has the ability to lyse activated B cells. Danazol increases CD4 +T cells. Romiplostim increases platelet production.

A patient with initial symptoms of immune thrombocytopenic purpura (ITP) receives corticosteroid therapy. The nurse recalls that the medication will produce which results? Select all that apply. a. Lyse activated B cells b. Increased CD4 +T cells c. Reduced capillary leakage d. Depressed antibody formation e. Increased platelet production

c. "It is designed to minimize the spread of germs to you from sources outside your environment." The primary purpose of protective, or reverse, isolation is to reduce transmission of organisms to the patient from sources outside the patient's environment. The use of special techniques to destroy discharge or handle the patient's linen and personal items and preventing the spread from the patient to others are not the purpose of protective isolation.

A patient with neutropenia asks how the prescribed protective (reverse) isolation helps prevent the spread of organisms. Which response by the nurse is appropriate? a. "It is designed to use special techniques to decrease discharge from your body." b. "It is designed to use special techniques to handle your linens and personal items." c. "It is designed to minimize the spread of germs to you from sources outside your environment." d. "It is designed to minimize the spread of germs from you to health care personnel, visitors, and other patients."

c. Infusion of lactated Ringer's solution Frequent vomiting and gastric suction decrease the level of electrolytes, such as sodium, potassium, and chloride. Lactated Ringer's solution is infused to correct electrolyte imbalances. Creon is a pancreatic enzyme supplement that is administered to correct enzyme deficiency in pancreatitis. A calcium gluconate infusion is given to treat muscle tetany associated with hypocalcemia. Dicyclomine is an antispasmodic and is effective in relieving muscle spasms.

A patient with pancreatitis has a nasogastric tube connected to low intermittent gastric suction. Which intervention would the nurse expect to be prescribed? a. Infusion of calcium gluconate b. Administration of dicyclomine c. Infusion of lactated Ringer's solution d. Administration of oral pancreatic enzymes

a. Hypocalcemia d. Hypomagnesemia Acute pancreatitis is associated with complications of hypocalcemia and hypomagnesemia. Hypocalcemia is manifested by jerking, irritability, and numbness in fingers and around the lips. Hypomagnesemia causes weakness, abnormal heart rhythms, and tremors. Hypoglycemia and hyponatremia are not seen in pancreatitis. Increased serum AFP levels are seen in hepatocellular cancer.

A patient with pancreatitis is irritable, has jerking movements, and reports a loss of sensation in the fingers. Which laboratory test results would the nurse expect? Select all that apply. a. Hypocalcemia b. Hypoglycemia c. Hyponatremia d. Hypomagnesemia e. Increased serum α-fetoprotein (AFP)

b. Morphine d. Dicyclomine The patient's signs and symptoms indicate a possible paralytic ileus; antispasmodics such as dicyclomine and pain relievers such as morphine, which can cause constipation, are contraindicated in patients with paralytic ileus. Mylanta, omeprazole, and acetazolamide are not contraindicated with paralytic ileus.

A patient with severe acute pancreatitis has abdominal distention, frequent belching, and excessive flatulence. Which drug in the patient's medication orders would the nurse hold until the health care provide is contacted? Select all that apply. a. Mylanta b. Morphine c. Omeprazole d. Dicyclomine e. Acetazolamide

b. Milk thistle may affect liver enzymes and alter drug metabolism. Milk thistle does affect liver enzymes and thus could alter drug metabolism. Therefore patients will need to be monitored for drug interactions. It is noted to be safe for up to six years, not 10 years. There is good scientific evidence that there is no real benefit from using milk thistle to protect the liver cells from toxic damage in the treatment of cirrhosis. It may lower, not elevate, blood glucose levels.

A patient with type 2 diabetes and cirrhosis asks the nurse whether it would be okay to take silymarin (milk thistle) to help minimize liver damage. Which information provides a rationale for the nurse's response? a. Milk thistle is safe in recommended doses for up to 10 years. b. Milk thistle may affect liver enzymes and alter drug metabolism. c. There is unclear scientific evidence for the use of milk thistle in treating cirrhosis. d. Milk thistle may elevate the serum glucose levels and thus is contraindicated in diabetes.

c. Following measures to gain tighter glucose control NAFLD can progress to liver cirrhosis. There is no definitive treatment, and therapy is directed at reduction of risk factors, which include treatment of diabetes, reduction in body weight, and elimination of harmful medications. For those who are overweight, weight reduction is important. Weight loss improves insulin sensitivity and reduces liver enzyme levels. NAFLD does not show up positive on a genetic test. It is not recommended to eliminate carbohydrates from the diet. NAFLD is not caused by alcohol, and the question does not imply that the patient drinks.

A patient with type 2 diabetes mellitus has been diagnosed with non-alcoholic fatty liver disease (NAFLD). Which information would the nurse include in the teaching plan? a. Recommending genetic testing b. Eliminating carbohydrates from the diet c. Following measures to gain tighter glucose control d. Avoiding alcohol until liver enzymes return to normal

a. Acute lymphocytic leukemia (ALL) Patients with ALL have a high probability of having leukemic infiltration of the CNS. The spread of leukemia to the CNS is not expected in CLL. AML does not typically infiltrate the CNS. CML is not associated with leukemic spread to the CNS.

A patient with which type of leukemia is likely to experience central nervous system (CNS) manifestations of the disease? a. Acute lymphocytic leukemia (ALL) b. Chronic lymphocytic leukemia (CLL) c. Acute myelogenous leukemia (AML) d. Chronic myelogenous leukemia (CML)

b. Palpitations An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL.

A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation? a. Glossitis b. Palpitations c. Dyspnea at rest d. Roaring in the ears

c. Desmopressin acetate (DDAVP) DDAVP, an analog of antidiuretic hormone, is the hormone replacement choice for central DI. Thiazide diuretics are used with nephrogenic DI because it does not respond to hormone therapy. Indomethacin is given for nephrogenic DI after a lowsodium diet and when thiazide drugs are not effective. Fluid is not restricted; a patient with DI will need fluid-replacement therapy due to severe dehydration.

About which treatment would the nurse plan to teach a patient who is newly diagnosed with central diabetes insipidus (DI)? a. Indomethacin b. Thiazide diuretics c. Desmopressin acetate (DDAVP) d. Fluid restrictions

d. Adrenocorticotropic hormone (ACTH) Adrenocortical insufficiency occurs as a result of an inadequate amount of serum cortisol, which occurs as a result of undersecretion of ACTH by the anterior pituitary. ADH and FSH are both secreted by the posterior pituitary, not the anterior pituitary. TSH is secreted by the anterior pituitary, but it acts on the thyroid gland to secrete thyroid hormones.

Adrenocortical insufficiency develops secondary to inadequate secretion of which pituitary hormone? a. Antidiuretic hormone (ADH) b. Follicle-stimulating hormone (FSH) c. Thyroid-stimulating hormone (TSH) d. Adrenocorticotropic hormone (ACTH)

a. 15 seconds Triaging should be done in 15 seconds at the scene of an emergency or MCI. Thirty seconds, one minute, and five minutes are too long for triage purposes.

After a mass casualty incident (MCI), how long will the nurse who is at the scene of the MCI take to assess each victim? a. 15 seconds b. 30 seconds c. One minute d. Five minutes

c. Combination chemotherapy The initial treatment for AML will be combination chemotherapy. If the white blood cell count is higher than 100,000/µL, then leukapheresis may be needed, but there is no indication that leukapheresis is needed currently. Total body radiation may be done prior to hematopoietic stem cell transplantation (HSCT), but remission will be achieved with chemotherapy first. HSCT may be an option, but remission with chemotherapy will be achieved prior to considering HSCT.

After a patient is diagnosed with acute myelogenous leukemia (AML), which topic will the nurse plan to teach first? a. Leukapheresis b. Total body radiation c. Combination chemotherapy d. Hematopoietic stem cell transplant

d. CT e. Positron emission tomography (PET) CT and PET are used to locate all sites of abnormal lymph node enlargement and organ involvement, data which determines the stage of the lymphoma. Lumbar puncture might be used in non-Hodgkin's lymphoma to determine whether there is central nervous system involvement. Bone marrow biopsy is used to check for bone marrow infiltration by the abnormal lymphocytes. A complete blood count will show whether there are nonspecific findings such as anemia or thrombocytopenia.

After a patient lymph node biopsy is positive for lymphoma, which diagnostic tests will the nurse anticipate for staging of the lymphoma? Select all that apply. a. Lumbar puncture b. Bone marrow biopsy c. Complete blood count d. CT e. Positron emission tomography (PET)

d. "In stage II, there is an involvement of two or more lymph nodes on both sides of the diaphragm." In stage II of Hodgkin's disease and non-Hodgkin's disease, there is an involvement of two or more lymph nodes on one side of the diaphragm but not both sides of diaphragm. In stage I, there is an involvement of a single lymph node, generally the cervical node. In stage IV, there is involvement of other organs besides lymph nodes, such as the liver or bone marrow. In stage III, there is lymph node involvement above and below the diaphragm.

After the nurse educator has discussed the staging of Hodgkin's lymphoma with students, which statement made by a student indicates a need for more teaching? a. "In stage I, there is an involvement of a single lymph node." b. "In stage IV, there is an involvement outside the lymph nodes." c. "In stage III, there is lymph node involvement above and below the diaphragm." d. "In stage II, there is an involvement of two or more lymph nodes on both sides of the diaphragm."

a. Partial remission In partial remission, there will be a lack of symptoms, and the peripheral blood smear will appear to be normal; however, evidence of disease in the bone marrow can be observed. In complete remission, there will be a lack of symptoms and no evidence of disease in the bone marrow. In molecular remission, all molecular studies are negative for residual leukemia. In minimal residual disease, tumor cells are not detected by morphologic examination but can be identified by molecular testing.

After treatment for leukemia, a patient no longer experiences symptoms, and the peripheral blood smear is normal, although there are abnormal cells in the bone marrow. The patient is in which stage of remission? a. Partial remission b. Complete remission c. Molecular remission d. Minimal residual disease

a. Check the identifying information on the unit of blood against the patient's ID bracelet. The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should match exactly the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, then the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's because it will cause red blood cell (RBC) hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started because this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.

Before beginning a transfusion of red blood cells (RBCs), which nursing action is the highest priority to avoid an error during the procedure? a. Check the identifying information on the unit of blood against the patient's ID bracelet. b. Select a new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. c. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. f. Add the blood transfusion as a secondary line to an existing IV and use the IV controller to maintain correct flow.

a. Patient with a red tag A red tag indicates a life-threatening injury that requires immediate intervention. Blue indicates those who are expected to die. Green is for minor injuries like sprains or minor lacerations. Yellow tags are used for urgent, but not life-threatening, injuries like open fractures.

Following field triaging for a mass casualty incident, which patient arriving in the emergency department will receive the most rapid intervention? a. Patient with a red tag b. Patient with a blue tag c. Patient with a green tag d. Patient with a yellow tag

d. Decreased fertility rate When a hypophysectomy is performed on the pituitary gland, it may result in damage to the pituitary gland, which affects the release of FSH and LH associated with reproduction and development of eggs in women. Therefore decreased fertility rate is a side effect of the surgery. Memory impairment, increased weight gain, and slowed speech are manifestations of hypothyroidism.

For which complication would a 35-year-woman who had a hypophysectomy and who developed a deficiency of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) be at risk? a. Slowed speech b. Impaired memory c. Increase in weight d. Decreased fertility rate

c. Double the number of patients who arrive during the first hour after the MCI. The total number of victims of an MCI who will need treatment in the hospital is estimated by doubling the number of victims seen in the first hour. Calculation of 30% or 50% of the total number of victims will not be accurate because victims may be transported to other hospitals. Since most patients of an MCI will be seen in the ED within the first day, it will not be useful to base planning on the number of victims seen in the first 24 hours.

How will the emergency department (ED) nurse manager estimate how many patients will need treatment in the ED after a mass casualty incident (MCI)? a. Calculate 30% of the people injured in the MCI. b. Calculate 50% of the people injured in the MCI. c. Double the number of patients who arrive during the first hour after the MCI. d. Double the number of patients who arrive during the first 24 hours after the MCI.

c. Petechiae Petechiae are minute hemorrhages into the skin that are seen in patients with bleeding disorders, such as thrombocytopenia. Purpura are larger discolored areas of bleeding that may occur when multiple petechiae coalesce. Bruises are larger areas of bleeding into the skin that occur with thrombocytopenia and might also be noted by the nurse in this patient. Ecchymoses are also larger areas of bleeding seen under the skin in patients with thrombocytopenia or other bleeding disorders.

How will the nurse document the finding after noting multiple 1-mm red macules when assessing the skin of a patient with leukemia and thrombocytopenia? a. Purpura b. Bruising c. Petechiae d. Ecchymosis

b. 1045 The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank, which would be at 1045. 1030, 1100, and 1115 are not consistent with this policy.

If a unit of packed red blood cells is picked up from the laboratory at 1015, the nurse would plan to hang the unit to begin infusion no later than which time? a. 1030 b. 1045 c. 1100 d. 1115

b. Dopamine Acute pancreatitis is associated with hypotension. Therefore, to return the BP to normal, vasoactive drugs such as dopamine may be prescribed. These drugs increase the total vascular resistance, thereby increasing BP. Morphine is an analgesic and is used to relieve pain. Omeprazole is an antacid that reduces the production of gastric hydrochloric acid (HCl). Pancrelipase is a synthetic enzyme and is prescribed for chronic pancreatitis in which there is a deficiency of pancreatic enzymes.

The BP of a patient with pancreatitis dropped from 125/80 mm Hg to 90/60 mm Hg. The nurse administers isotonic fluid without an increase in the patient's BP. Which medication would the nurse anticipate will be prescribed by the health care provider? a. Morphine b. Dopamine c. Omeprazole d. Pancrelipase

c. Disseminated intravascular coagulation (DIC) DIC increases the PT and aPTT because of impaired synthesis of clotting factors. The PT and aPTT are normal in HIT, ITP, and TTP.

The diagnostic reports of a patient with severe bleeding reveal elevated prothrombin time (PT) and activated partial thromboplastin time (aPTT). The nurse suspects which condition? a. Heparin-induced thrombocytopenia (HIT) b. Immune thrombocytopenic purpura (ITP) c. Disseminated intravascular coagulation (DIC) d. Thrombotic thrombocytopenic purpura (TTP)

d. "An injection of immunoglobulin will need to be given to prevent or minimize the effects of exposure." Immunoglobulin provides temporary (one to two months') passive immunity and is effective for preventing hepatitis A if given within two weeks after exposure. The hepatitis vaccine is used only for preexposure prophylaxis. Testing for prior exposure is not needed. Immunoglobulin may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which response would the nurse provide? a. "The hepatitis vaccine will provide immunity from this exposure and future exposures." b. "I am afraid there is nothing you can do because the patient was infectious before admission." c. "You will need to be tested first to make sure you don't have the virus before we can treat you." d. "An injection of immunoglobulin will need to be given to prevent or minimize the effects of exposure."

d. Ammonia levels Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy. Lactulose does not decrease liver enzymes. Lactulose causes diarrhea as a side effect, but that is not the intended effect. Lactulose does not relieve abdominal pain.

The health care provider prescribes lactulose for a patient with hepatic encephalopathy. Which data would the nurse monitor for effectiveness of this medication? a. Liver enzymes b. Stool frequency c. Abdominal pain d. Ammonia levels

c. Platelet count of 150,000/mcL The platelet count of 150,000/mcL in a patient who is on heparin therapy indicates for heparin-induced thrombocytopenia (HIT) and requires warfarin therapy. Thrombolytic agents should be used to treat a thromboembolic event. Plasmapheresis should be performed during severe clotting. The platelet count of 180,000/mcL does not indicate the need for warfarin therapy in the patient. Warfarin reverses HIT and prevents microvascular thrombosis in the patient.

The nurse anticipates a prescription for warfarin therapy based on which assessment finding? a. Signs of thrombolytic agents b. Signs of severe blood clotting c. Platelet count of 150,000/mcL d. Platelet count of 180,000/mcL

c. Epistaxis The signs of hemorrhage that are manifested by changes in mucous membranes include epistaxis and gingival oozing. The signs of hemorrhage such as pallor, purpura, and hematoma are associated with the integumentary system.

The nurse assesses a patient and identifies signs of hemorrhage based on which changes in the mucous membranes? a. Pallor b. Purpura c. Epistaxis d. Hematoma

a. Vertigo b. Dyspnea at rest d. Jaundice and pruritus e. Glossitis and smooth tongue In severe anemia (Hgb less than 6 g/dL [60 g/L]), the patient has many clinical manifestations involving multiple body systems, including vertigo, dyspnea at rest, jaundice and pruritus, and glossitis and smooth tongue. The patient will not have sensitivity to heat, but rather a sensitivity to cold.

The nurse assesses a patient who has severe anemia and expects to find which manifestations? Select all that apply. a. Vertigo b. Dyspnea at rest c. Sensitivity to heat d. Jaundice and pruritus e. Glossitis and smooth tongue

d. Red, beefy tongue The decreased absorption of vitamin B resulting from a lack of intrinsic factor causes a decrease in hemoglobin, hematocrit, and red blood cells. A smooth, red, enlarged or "beefy" appearance of the tongue may also be seen. Intrinsic factor is produced by the parietal cells of the stomach lining and is required to absorb vitamin B from the intestines. Causes of decreased intrinsic factor production include surgical alterations such as gastrectomy and autoimmune disease. Diarrhea, indigestion, and flushed skin appearance are not signs specifically associated with pernicious anemia.

The nurse assesses a patient with pernicious anemia and expects to find which classic sign of this condition? a. Diarrhea b. Indigestion c. Flushed skin d. Red, beefy tongue

c. Increased hemoglobin In polycythemia vera, hemoglobin and hematocrit are increased because of a hyperproliferation of red blood cells. Orthopnea, peripheral edema, and increased C-reactive protein are not associated with polycythemia vera.

The nurse caring for a patient with polycythemia vera would expect which assessment finding? a. Orthopnea b. Peripheral edema c. Increased hemoglobin d. Increased C-reactive protein

b. Increased bleeding time d. Increased partial thromboplastin time Increased bleeding time is observed in patients with von Willebrand disease because of structurally defective platelets. The patient with von Willebrand disease will have a deficiency in the intrinsic clotting system factor; therefore the partial thromboplastin time may be prolonged. Decreased factor IX is associated with hemophilia B. The thrombin time remains normal in patients with von Willebrand disease because it does not impair thrombin-fibrinogen reaction. A decreased platelet count is seen in patients with thrombocytopenia. However, platelet counts remain normal in von Willebrand disease because there will be adequate platelet production.

The nurse concludes that a patient has von Willebrand disease based on a decreased von Willebrand coagulation factor (vWF) and which other laboratory parameters? Select all that apply. a. Decreased factor IX b. Increased bleeding time c. Increased thrombin time d. Decreased platelet count d. Increased partial thromboplastin time

a. Air hunger b. Clammy skin e. Decreased central venous pressure Air hunger, clammy skin, and a decreased central venous pressure are the clinical manifestations seen in a patient who has sustained 2000 mL of acute blood loss. Lactic acidosis may occur in cases of 2500 mL of acute blood loss. Rare vasovagal syncope may occur if 500 mL of acute blood loss occurs.

The nurse expects to observe which manifestations in a patient who experienced an acute blood loss of 2000 mL? Select all that apply. a. Air hunger b. Clammy skin c. Lactic acidosis d. Vasovagal syncope e. Decreased central venous pressure

b. Immune thrombocytopenic purpura (ITP) Viral infections compromise the immune system and contribute to the development of ITP. Hereditary thrombocytopenia is observed in the patient with inherited thrombocytopenia. HIT is observed in the patient who is on long-term heparin therapy. TTP is observed in a patient with hemolytic anemia.

The nurse is caring for a patient with a viral infection and recognizes that the patient is at risk for which type of thrombocytopenia? a. Hereditary thrombocytopenia b. Immune thrombocytopenic purpura (ITP) c. Heparin-induced thrombocytopenia (HIT) d. Thrombotic thrombocytopenic purpura (TTP)

a. Increased abdominal pain A patient with pancreatitis experiences severe pain if he or she has intolerance to oral foods. A patient who shows intolerance to oral foods also experiences increased (not decreased) abdominal girth and elevated levels of serum lipase and amylase.

The nurse is caring for a patient with pancreatitis who is prescribed a regular diet. Which finding indicates to the nurse that food and fluids should be withheld for this patient? a. Increased abdominal pain b. Decreased abdominal girth c. Decreased serum lipase levels d. Decreased serum amylase levels

b. Rinse the mouth frequently. Parotitis is inflammation of the parotid gland, which is located inside the mouth. Therefore to reduce the risk for developing parotitis, the nurse should encourage the patient to perform oral care by rinsing the mouth frequently. Though hand hygiene prevents the spread of infection, it is not beneficial in preventing parotitis. Moisturizing the hands will prevent dry skin. Deep-breathing exercises are effective for relieving anxiety.

The nurse is caring for a patient with pancreatitis. Which action would the nurse encourage the patient to take to reduce the risk for parotitis? a. Perform hand hygiene. b. Rinse the mouth frequently. c. Moisturize hands before sleeping. d. Practice deep-breathing exercises.

a. Orthopnea b. Tachypnea c. Dyspnea at rest The compensatory respiratory changes that occur in severe anemia are orthopnea, tachypnea, and dyspnea at rest. Impaired thought process is a neurologic symptom associated with severe anemia. Dyspnea on exertion is seen in mild anemia.

The nurse is caring for a patient with severe anemia. The nurse expects which compensatory respiratory changes? Select all that apply. a. Orthopnea b. Tachypnea c. Dyspnea at rest d. Dyspnea on exertion e. Impaired thought process

c. Assess the pulse of the extremity. After the movement of an injured extremity, the nurse will assess the pulse to ensure the extremity is receiving circulation. Elevation, immobilization, and applying ice packs to the injured area are not initial actions the nurse takes after moving the extremity.

The nurse is conducting a secondary survey for a patient involved in a motor vehicle accident. Which initial action does the nurse take after moving the patient's injured extremity? a. Elevate the extremity. b. Immobilize the extremity. c. Assess the pulse of the extremity. d. Apply ice packs to the injured area.

a. Monitor electrolyte levels. b. Assess respiratory function. c. Provide psychologic support. e. Observe for muscular twitching. Frequent gastric suctioning is performed in patients with severe acute pancreatitis, which may result in decreased levels of the electrolytes, sodium, potassium, calcium, and chloride; therefore electrolyte levels should be monitored. The nurse should assess respiratory function by determining the lung sounds and oxygen saturation levels. Patients with serious conditions should receive psychologic support to cope. Hypocalcemia results in muscular twitching and jerking movement, so the nurse should look for muscle twitching in the patient. Acute pancreatitis is not treated surgically unless a specific complication, such as abscess, develops.

The nurse is developing a plan of care for a patient with acute pancreatitis. Which nursing actions would be included in the plan of care? Select all that apply. a. Monitor electrolyte levels. b. Assess respiratory function. c. Provide psychologic support. d. Prepare the patient for surgery. e. Observe for muscular twitching.

b. I can have normal food that is low in fat. c. I may have mild shoulder pain for a week. After the procedure, the diet should be high in fiber and low in fat. Having mild shoulder pain after cholecystectomy is common due to diaphragmatic irritation. After cholecystectomy, it is essential that the patient doesn't lift heavy weights for weeks so that abdominal pressure doesn't increase. The patient can bathe and shower normally after a couple of days. The patient doesn't need to follow a liquid diet.

The nurse is planning discharge teaching for a patient after a laser laparoscopic cholecystectomy. Which patient statements indicate understanding of the discharge teaching? Select all that apply. a. I cannot bathe or shower for 10 days. b. I can have normal food that is low in fat. c. I may have mild shoulder pain for a week. d. I should be able to lift weights in two to three days. e. I should have only a liquid diet for the first week.

b. An endoscope is passed into the duodenum. c. The endoscope leaves the stone in the duodenum. e. The stent associated with ERCP can be removed after a few months. ERCP involves the passage of an endoscope into the duodenum and allows visualization of the biliary system. An endoscope used in ERCP has an electrodiathermy knife attached to it, which cuts the stone and leaves it in the duodenum for easy elimination through the stool. The stent associated with ERCP can be removed or changed after a few months. ERCP does not extend to the colon. A colonoscopy would be used for visualization of the colon. Cholecystostomy is the surgical procedure that creates a stoma in the gallbladder.

The nurse is preparing education for a group of student nurses about endoscopic retrograde cholangiopancreatography (ERCP). Which information would the nurse include in the teaching? Select all that apply. a. ERCP allows visualization of the colon. b. An endoscope is passed into the duodenum. c. The endoscope leaves the stone in the duodenum. d. ERCP is performed to create a stoma in the gallbladder. e. The stent associated with ERCP can be removed after a few months.

d. Providing oral care every two hours Patients with cholecystitis may have severe nausea and vomiting. Therefore the nurse should give frequent oral care to the patient to provide comfort. Encouraging exercise, assisting with ambulation, and repositioning are not interventions that address the problem of severe nausea and vomiting.

The nurse is providing care to a patient with cholecystitis who is experiencing severe nausea and vomiting. Which intervention would the nurse plan to provide? a. Encouraging exercise b. Assisting with ambulation c. Assisting with repositioning d. Providing oral care every two hours

a. Resume normal activities gradually within one week. b. Eat a low-fat diet for several weeks after the surgery. d. Report any bile-colored drainage or pus from any incision. After a laparoscopic cholecystectomy, the nurse should instruct the patient to gradually resume normal activities, usually within one week. The nurse should also instruct the patient to have liquids for the rest of the day and eat light meals for a few days. The amount of fat in the postoperative diet depends on the patient's tolerance of fat. A lowfat diet may be helpful if the flow of bile is reduced (usually only in the early postoperative period) or if the patient is overweight. Sometimes the patient is instructed to restrict fats for four to six weeks. Otherwise, no special dietary instructions are needed other than to eat nutritious meals and avoid excessive fat intake. The bandages are to be removed the day after the surgery. Patients need to report any bile-colored drainage or pus from any incision. Patients who undergo a laparoscopic cholecystectomy will not have a T-tube present.

The nurse is providing discharge instructions to a patient and caregiver following a laparoscopic cholecystectomy. Which measures will be included in the discharge teaching? Select all that apply. a. Resume normal activities gradually within one week. b. Eat a low-fat diet for several weeks after the surgery. c. Keep the bandages on the puncture sites for three days. d. Report any bile-colored drainage or pus from any incision. e. Empty and measure the contents of the bile bag from the T-tube every day.

a. Resume normal activities gradually within one week. b. Eat a low-fat diet for several weeks after the surgery. e. Empty and measure the contents of the bile bag from the T-tube every day. After a laparoscopic cholecystectomy, the nurse should instruct the patient to gradually resume normal activities, usually within one week. The nurse should also instruct the patient to have liquids for the rest of the day and eat light meals for a few days. The amount of fat in the postoperative diet depends on the patient's tolerance of fat. A low-fat diet may be helpful if the flow of bile is reduced (usually only in the early postoperative period) or if the patient is overweight. Sometimes the patient is instructed to restrict fats for four to six weeks. Otherwise, no special dietary instructions are needed other than to eat nutritious meals and avoid excessive fat intake. The bandages are to be removed the day after the surgery. Patients need to report any bile-colored drainage or pus from any incision. Patients who undergo a laparoscopic cholecystectomy will not have a T-tube present.

The nurse is providing discharge instructions to a patient and caregiver following a laparoscopic cholecystectomy. Which measures will be included in the discharge teaching? Select all that apply. a. Resume normal activities gradually within one week. b. Eat a low-fat diet for several weeks after the surgery. c. Keep the bandages on the puncture sites for three days. d. Report any bile-colored drainage or pus from any incision. e. Empty and measure the contents of the bile bag from the T-tube every day.

c. Avocados d. Red meat Avocado contains niacin, which is required for the maturation of RBC. Red meat is rich in cobalamin (vitamin B ). Cobalamin is an essential nutrient that plays an important role in erythropoiesis by enhancing the RBC maturation. Therefore the nurse would expect these two food sources to promote red blood cell (RBC) maturation. Shellfish contains copper, which is an essential nutrient useful for mobilization of iron from tissues to plasma. Bananas and cornmeal are rich in pyridoxine (vitamin B ), which is essential for hemoglobin synthesis.

The nurse provides dietary teaching to a patient with anemia and would include which food sources to promote red blood cell (RBC) maturation? Select all that apply. a. Shellfish b. Bananas c. Avocados d. Red meat e. Cornmeal

d. "Now that the blood loss is controlled and as your blood volume is replaced, the anemia generally corrects itself, so no long-term treatment is needed." Anemia caused by acute blood loss generally resolves itself once the source of the bleeding is identified and controlled and blood/fluid volume is replaced. It is incorrect to tell the patient he or she will need supplements for the rest of his or her life, that dietary changes will be necessary for the next year or two, or that several supplements are necessary to prevent recurrence.

The nurse is providing discharge instructions to a patient who has anemia secondary to acute blood loss. Which instruction would the nurse include in the discharge teaching? a. "You will need to take an iron supplement for the rest of your life to make sure the anemia does not return." b. "You will need to make dietary changes to help support the production of red blood cells for the next one to two years." c. "It would be best to take several supplements to prevent the anemia from recurring, including folic acid, niacin, and riboflavin." d. "Now that the blood loss is controlled and as your blood volume is replaced, the anemia generally corrects itself, so no long-term treatment is needed."

b. Report development of jaundice. c. You can shower the day after surgery. e. Eat several small meals and snacks each day. Teach the patient signs and symptoms of obstruction to report (e.g., stool and urine changes, jaundice, itching). The patient may remove the bandages on the puncture sites the day after surgery and shower. It is helpful to eat three small meals and two or three snacks daily rather than three large meals to help reduce the flow of bile after the surgery. Eating fat-rich foods will stimulate the release of bile, so the patient should consider eating lighter meals. Return to work is generally permitted in one week; it would be dangerous to return the same day of surgery after general anesthesia.

The nurse is providing discharge instructions to a patient who has undergone a laparoscopic cholecystectomy. Which information would the nurse include in the teaching? Select all that apply. a. Eat foods rich in fatty acids. b. Report development of jaundice. c. You can shower the day after surgery. d. You can return to work the day of surgery. e. Eat several small meals and snacks each day.

b. Observing for signs of bleeding c. Maintaining the patient on bed rest d. Observing for any change in body temperature Patients who undergo ERCP are at risk of developing infection, bleeding, and pancreatitis. Therefore the nurse should observe for signs of bleeding, encourage bed rest, and monitor for changes in body temperature. Gag reflex is absent after the surgery, and the nurse should wait for the gag reflex to return before providing food or fluids.

The nurse is providing immediate postprocedural care to a patient who underwent endoscopic retrograde cholangiopancreatography (ERCP). Which actions would the nurse take? Select all that apply. a. Providing a soft meal b. Observing for signs of bleeding c. Maintaining the patient on bed rest d. Observing for any change in body temperature e. Encouraging the patient to drink plenty of fluids

a. Report 1 Uptake noted in a single cervical lymph node aligns with stage I lymphoma because a single node is positive. Uptake noted in cervical and mediastinal lymph is stage II lymphoma because multiple nodes on one side of the diaphragm are positive. Uptake noted in cervical and mesenteric lymph nodes align with stage III lymphoma because multiple nodes are involved on both sides of the diaphragm. Uptake noted in cervical, mediastinal, mesenteric, and hepatic areas aligns with stage IV lymphoma because multiple nodes are involved on both sides of the diaphragm and outside the diaphragm in the hepatic area.

The nurse is reviewing imaging results on lymphoma patients. Which report reflects nodal involvement at stage I? a. Report 1 b. Report 2 c. Report 3 d. Report 4

b. Report 2 Uptake noted in cervical and mediastinal lymph is stage II lymphoma because multiple nodes on one side of the diaphragm are positive. Uptake noted in a single cervical lymph node aligns with stage I lymphoma because a single node is positive. Uptake noted in cervical and mesenteric lymph nodes align with stage III lymphoma because multiple nodes are involved on both sides of the diaphragm. Uptake noted in cervical, mediastinal, mesenteric, and hepatic areas aligns with stage IV lymphoma because multiple nodes are involved on both sides of the diaphragm and outside the diaphragm in the hepatic area.

The nurse is reviewing imaging results on lymphoma patients. Which report reflects nodal involvement at stage II? a. Report 1 b. Report 2 c. Report 3 d. Report 4

c. Nutrition This patient with chronic pancreatitis has impaired pancreatic function which alters the digestion and absorption of nutrients. This results in the 10-pound weight loss, decreased albumin, and increased blood glucose levels, which would lead the nurse to prioritize improving the patient's nutritional status. Acute pancreatitis leads to increased pain. The patient reports mild discomfort so this would not be the highest priority. The slightly increased WBC reflects the inflammation of the pancreas, not infection. The patient has darker urine due to impaired bilirubin metabolism, not dehydration, so fluid volume is not the priority.

The nurse is reviewing the health record of a patient admitted with chronic pancreatitis. Based on these findings, which aspect of patient care would the nurse prioritize? a. Pain management b. Infection c. Nutrition d. Fluid volume

c. Acute pancreatitis The primary diagnostic tests for acute pancreatitis are serum amylase and lipase. The serum amylase level usually is elevated early and remains elevated for 24 to 72 hours. Serum lipase level, which also is elevated in acute pancreatitis, is an important test because other disorders (e.g., mumps, cerebral trauma, renal transplantation) may increase serum amylase levels. Other findings include an increase in liver enzymes, triglycerides, glucose, and bilirubin, and a decrease in calcium. Liver cirrhosis, acute hepatitis, and chronic pancreatitis do not apply to these chart levels.

The nurse is reviewing the laboratory reports of a patient who was admitted with sudden severe abdominal pain. Which condition is consistent with the test results? a. Liver cirrhosis b. Acute hepatitis c. Acute pancreatitis d. Chronic pancreatitis

c. Prolonged bleeding after a minor tooth extraction The nurse would suspect a bleeding disorder such as von Willebrand disease if a patient experiences abnormally prolonged bleeding following a tooth extraction. Hypertension is not related to bleeding; blood loss is associated with hypotension. An elevated platelet count usually results in abnormal clotting. A fractured scapula following positioning in the bed could indicate osteoporosis.

The nurse suspects a patient may have von Willebrand disease. Which assessment finding supports the nurse's suspicion? a. Hypertension b. Elevated platelet count c. Prolonged bleeding after a minor tooth extraction d. Fractured scapula after turning and positioning in bed

b. "I will need to administer narcotics for pain control." d. "The patient will use a bedside commode for the first 24 hours after surgery." e. "The patient will need to return to the office in 10 days for removal of stitches." Postoperative pain can usually be controlled with over-the-counter pain relievers. Patients who have undergone laparoscopic cholecystectomy can usually walk to the bathroom, so there is no need for a bedside commode. With laparoscopic cholecystectomy, there are small incisions that are covered by small adhesive bandages that can be removed in about five days. The stitches dissolve over time. A cholecystectomy may result in changes in prothrombin time and may cause bleeding. Therefore the nurse should monitor for bleeding. Deep-breathing exercises should be encouraged to prevent postoperative pneumonia and to help relieve the patient's discomfort.

The nurse is teaching a student nurse about postoperative care for a patient who has undergone laparoscopic cholecystectomy. Which statements made by the student nurse indicate the need for further teaching? Select all that apply. a. "I will monitor for bleeding." b. "I will need to administer narcotics for pain control." c. "I will encourage the patient to practice deep breathing." d. "The patient will use a bedside commode for the first 24 hours after surgery." e. "The patient will need to return to the office in 10 days for removal of stitches."

b. Cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Splenectomy is removal of the spleen. Cholecystojejunostomy is a surgical formation of means of communication between the gallbladder and jejunum. Pancreaticoduodenectomy involves removal of the pancreas, gallbladder, and other organs.

The nurse notes that a patient is scheduled for a gallbladder removal. Which name for the procedure will be on the consent form? a. Splenectomy b. Cholecystectomy c. Cholecystojejunostomy d. Pancreaticoduodenectomy

b. 1200 The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank. Because the blood was picked up at 1130, 1200 is the latest it can be hung. It is okay to hang the blood at 1145. It is too late to hang the blood at 1230 or at 1530.

The nurse picks up a unit of packed red blood cells from the laboratory at 1130. The nurse would initiate the patient's transfusion no later than which time? a. 1145 b. 1200 c. 1230 d. 1530

a. Pulmonary edema c. Impaired alveolar ventilation d. Increased pulmonary pressures Drowning victims who aspirate water develop pulmonary edema, which can cause acute respiratory distress syndrome. Hypertonic saltwater draws fluid from the vascular space into the alveoli, impairing alveolar ventilation and causing hypoxia. The body tries to compensate for hypoxia by shunting blood to the lungs. This results in increased pulmonary pressures and deteriorating respiratory status. More and more blood is shunted through the alveoli. Because the blood is not adequately oxygenated, hypoxemia worsens. This can result in cerebral injury, edema, and brain death. Hypertonicity of fresh water alters the fluid balance in the body. Fresh water is often contaminated, which creates a breakdown of surfactant in the lungs.

The nurse provides care for a drowning victim who aspirated hypertonic saltwater. Which pathophysiology is associated with the aspiration of this type of fluid? Select all that apply. a. Pulmonary edema b. Fluid imbalance in the body c. Impaired alveolar ventilation d. Increased pulmonary pressures e. Breakdown of the surfactant in the lungs

a. Administer oxygen. b. Monitor airway patency. d. Maintain the patient in a supine position. Administering oxygen, monitoring airway patency, and maintaining the patient in a supine position on a flat bed are initial actions the nurse will take during the primary survey of the patient suspected of having a spinal cord injury. IV lines are inserted to provide circulatory support and are not included in the initial actions of a primary survey. There is no indication that the patient's airway is unprotected; therefore it is not necessary to prepare the patient for rapid-sequence intubation.

The nurse provides care for a patient who is suspected of having a spinal cord injury and is immobilized with a cervical collar. Which initial actions does the nurse take during the primary survey of this patient? Select all that apply. a. Administer oxygen. b. Monitor airway patency. c. Initiate IV lines. d. Maintain the patient in a supine position. e. Prepare the patient for rapid-sequence intubation.

b. Decreased production of platelets The normal platelet count is in the range of 150,000 to 450,000 platelets/mcL of blood. A decreased blood platelet count indicates thrombocytopenia in the patient. A patient with ITP will have thrombocytopenia because of decreased platelet production. Ingestion of herbs results in thrombocytopenia by destroying the platelets. Enhanced aggregation of platelets is associated with thrombotic thrombocytopenic purpura (TTP). Increased consumption of platelets will cause heparin-induced thrombocytopenia (HIT).

The nurse provides care for a patient with immune thrombocytopenic purpura (ITP) who has a platelet count of 90,000/mcL of blood. Which occurrence could be the reason for this condition? a. Destruction of platelets b. Decreased production of platelets c. Enhanced aggregation of platelets d. Increased consumption of platelets

a. "I should avoid high altitudes." e. "I should start screening for retinopathy at age 10." Patients with SCD should avoid crises by avoiding activities that cause hypoxia. High altitudes can increase the risk for the development of hypoxia. Regular screenings for retinopathy are recommended. The patient should not drink orange juice too often because orange juice is rich in vitamin C. Eating uncooked seafood increases the risk of infection; this type of product is rich in iron and should be avoided. The pneumococcal injection is recommended to prevent infection.

The nurse provides discharge teaching to a patient with sickle cell disease (SCD). Which statements made by the patient indicate understanding of the teaching? Select all that apply. a. "I should avoid high altitudes." b. "I should drink orange juice quite often." c. "I can safely consume uncooked seafood." d. "I shouldn't receive the pneumococcal injection." e. "I should start screening for retinopathy at age 10."

a. To identify all injuries The secondary survey is used to identify all injuries. The primary survey is used to identify life-threatening conditions. Triage allows for an initial focused assessment and is used to categorize a patient's clinical condition so that the most critically ill are treated first.

The nurse provides education about emergency nursing for a group of nursing students. The nurse includes which primary purpose for the secondary survey? a. To identify all injuries b. To identify life-threatening conditions c. To perform an initial focused assessment d. To allow for the patient's clinical condition to be categorized

c. It is associated with hemolytic-uremic syndrome. TTP is an uncommon syndrome associated with hemolytic-uremic syndrome because both disorders are acute and characterized by thrombocytopenia and microangiopathic hemolytic anemia. TTP is caused by the deficiency of a plasma enzyme (ADAMTS13), not by a Helicobacter pylori infection. TTP is considered a medical emergency because bleeding and clotting occur simultaneously. TTP is associated with increased platelet aggregation; this causes the formation of microthrombi, which can get deposited in arterioles and capillaries.

The nurse provides education about thrombotic thrombocytopenic purpura (TTP) to a group of nursing students and would include which information? a. It is caused by Helicobacter pylori infection. b. It is not considered as a medical emergency. c. It is associated with hemolytic-uremic syndrome. d. It is associated with decreased platelet aggregation.

b. Shaving using an electric razor A patient with thrombocytopenia has a decreased number of platelets, and therefore prolonged bleeding will be observed even for minor injuries. Shaving using an electric razor blade decreases the risk for cuts and wounds, resulting in decreased bleeding. Therefore this activity of the patient indicates understanding of the nurse's teaching. Flossing using a thick tape floss is not safe and can cause an increased risk for bleeding. Walking with flip-flops can cause the patient to trip, causing the risk for cuts or wounds and increased bleeding. Brushing using a stiff-bristle toothbrush causes injury to the gums and is not safe; therefore the nurse needs to perform more patient teaching.

The nurse provides education regarding daily activities to a patient with thrombocytopenia. Which activity identified by the patient indicates understanding of the teaching? a. Flossing using thick tape floss b. Shaving using an electric razor c. Wearing flip-flops to go walking d. Brushing using a stiff-bristle toothbrush

a. "I will floss gently using thin tape floss." e. "I will apply firm pressure to the nostrils and bridge of the nose if a nosebleed occurs." Flossing is usually safe for patients with low platelet counts only if it is done gently using thin tape floss. Applying firm pressure to the nostrils and bridge of the nose would be beneficial to stop or decrease a nosebleed. Alcohol-based mouthwashes should not be used because they may dry the gums and increase bleeding. Patients with low platelet counts should not use tampons because they may increase the risk of bleeding. Therefore it is advisable to use sanitary pads during menstruation. Suppositories cannot be used without the permission of the health care provider because improper use may increase the risk of bleeding in patients with low platelet counts.

The nurse provides education to a patient with a low platelet count about precautions to be taken. Which statements made by the patient indicate effective learning? Select all that apply. a. "I will floss gently using thin tape floss." b. "I will use alcohol-based mouthwash." c. "I will use tampons instead of sanitary pads." d. "I will use a suppository laxative if experiencing constipation." e. "I will apply firm pressure to the nostrils and bridge of the nose if a nosebleed occurs."

c. "Oral dissolution therapy is used along with the procedure." Oral dissolution therapy is used along with extracorporeal shock-wave lithotripsy (ESWL) for facilitating removal of disintegrated gallstones. It is not used with ERCP. ERCP allows visualization of the biliary system and pancreatic duct. Attachments such as the electrodiathermy knife are used to cut up a gallstone, and a catheter with a wire basket can be used to retrieve a gallstone.

The nurse provides information to a student nurse about endoscopic retrograde cholangiopancreatography (ERCP). Which statement made by the student nurse indicates the need for further teaching? a. "It allows visualization of the biliary system." b. "The procedure enables inspection of the pancreatic duct." c. "Oral dissolution therapy is used along with the procedure." d. "Attachments to the endoscope are used to break up or retrieve stones."

a. Infectious agent Infectious agents, such as malaria, are extrinsic factors that can lead to acquired hemolytic anemias. Abnormal hemoglobin, such as sickle cell disease, and enzyme deficiencies are intrinsic factors that lead to hereditary (intrinsic) hemolytic anemias. Membrane abnormalities, such as paroxysmal nocturnal hemoglobinuria, cause increased red blood cell (RBC) destruction and are hereditary (intrinsic) factors.

The nurse recalls that hemolytic anemia can be caused by which extrinsic factors? a. Infectious agent b. Enzyme deficiency c. Sickle cell disease d. Membrane abnormalities

d. Heparin-induced thrombocytopenia (HIT) With HIT, heparin causes decreased platelet counts and increases the risk for hemorrhage. Patients who have had HIT should never be given heparin or low-molecular-weight heparin (LMWH). This should be clearly marked in the patient's medical record. Splenomegaly is an enlarged spleen; this often occurs with anemia and autoimmune disorders. Thromboembolism is another term for blood clot; heparin is used to treat clots and would not cause them. Hepatic encephalopathy occurs in alcoholic patients when brain tissue is destroyed due to decreased thiamine.

The nurse recalls that heparin should not be given to a patient with a history of which condition? a. Splenomegaly b. Thromboembolism c. Hepatic encephalopathy d. Heparin-induced thrombocytopenia (HIT)

c. Platelet factor 4 (PF4) binds to heparin. b. Complex binds to heparin. a. Complex binds to platelet surface. f. Positive feedback loop is created. d. Antibodies are created against the complex. e.. Antibodies are prematurely removed from circulation. Platelet destruction and vascular endothelial injury are the two major responses to an immune-mediated response to heparin. Initially, PF4 binds to heparin. This complex then binds to the platelet surface, and more PF4 are released. Because of this, a positive feedback loop is created. Antibodies are created against the complex, and they are removed prematurely from circulation, leading to thrombocytopenia and plateletfibrin thrombi.

The nurse recalls that the events that lead to heparin-induced thrombocytopenia occur in which order? a. Complex binds to platelet surface. b. Complex binds to heparin. c. Platelet factor 4 (PF4) binds to heparin. d. Antibodies are created against the complex. e.. Antibodies are prematurely removed from circulation. f. Positive feedback loop is created.

c. That competent and compassionate care is provided to all patients The standard of care for pain includes providing competent and compassionate care for all patients. The patient's pain assessment is not based on nursing judgment; it is based on the patient's self-report. The standard of care for pain includes providing the best possible relief under the circumstances. Notifying the health care provider regarding the effects of the pain medication should occur if the medication is not providing adequate pain relief for the patient.

The nurse recalls that the standard of care for pain includes which component? a. That the pain assessment is based on nursing judgment b. The minimal amount of intervention required to address pain c. That competent and compassionate care is provided to all patients d. Notifying the health care provider regarding the effects of the pain medication

d. The spleen affects the platelet-macrophage interaction. Splenectomy causes complete remission in a patient with ITP because the structural features of the spleen enhance the interaction between antibody-coated platelets and macrophages. The spleen sequesters approximately one third of the platelets, so removal of the spleen increases the number of platelets in circulation. The spleen contains abundant macrophages that sequester and destroy platelets. The spleen synthesizes some antibodies and thus antiplatelet antibodies decrease after splenectomy.

The nurse recognizes that a splenectomy is an appropriate treatment plan for a patient with immune thrombocytopenic purpura (ITP) because of which splenic function? a. The spleen sequesters total platelets. b. The spleen does not contain macrophages. c. The spleen does not synthesize any antibodies. d. The spleen affects the platelet-macrophage interaction.

a. It is relatively short-lived. Desmopressin acetate is relatively short-lived and therefore should be given in repeated doses to prolong its beneficial effects. Effectiveness of desmopressin acetate within 30 minutes does not indicate the need for repeated dosing. Increased stimulation of factor VIII and its action on platelets and endothelial cells do not indicate the need for repeated dosing.

The nurse recognizes that desmopressin acetate needs to be given to a patient in repeated doses for which reason? a. It is relatively short-lived. b. It is effective within 30 minutes. c. It stimulates an increase in factor VIII. d. It acts on platelets and endothelial cells.

d. Variable factor VIII deficiencies and platelet dysfunction Von Willebrand disease is characterized by a deficiency of the von Willebrand coagulation protein and variable factor VIII deficiencies and platelet dysfunction. Therefore the bleeding time is prolonged in the patient with von Willebrand disease. Adequate platelet production does not alter the normal bleeding time in a patient. Deficiency in intrinsic clotting system factor will alter the partial thromboplastin time (PTT). Impairment of thrombin fibrinogen reaction alters the thrombin time.

The nurse recognizes that patients with von Willebrand disease are at risk for prolonged bleeding times for which reason? a. Adequate platelet production b. Deficiency in intrinsic clotting system factor c. Impairment of thrombin fibrinogen reaction d. Variable factor VIII deficiencies and platelet dysfunction

c. Sore throat Sore throat is an assessment finding related to cognitive-perceptual health patterns in a patient with leukemia. Nausea comes under the nutritional-metabolic health pattern. Epistaxis is an assessment finding related to activity-exercise. Easy bruising also comes under the nutritional-metabolic health pattern.

The nurse recognizes that which assessment finding is related to cognitive-perceptual health patterns in a patient with leukemia? a. Nausea b. Epistaxis c. Sore throat d. Easy bruising

b. Hemochromatosis The normal range of total body iron is 2 to 6 g, and its concentration exceeds 50 g in case of hemochromatosis. Fatigue, arthralgia, abdominal pain, weight loss, and enlarged liver and spleen are the clinical manifestations of hemochromatosis. Polycythemia is characterized by laboratory manifestations such as elevated hemoglobin and red blood cell (RBC) count, low to normal erythropoietin, elevated white blood cell (WBC) count, platelet, uric acid, and cobalamin levels. The clinical manifestations include headaches, vertigo, dizziness, tinnitus, and visual disturbances. In patients with sickle cell disease, the peripheral blood smear will show sickled cells and abnormal reticulocytes. The patient may have elevated serum bilirubin levels and bone and joint deformities. In patients with iron-deficiency anemia, the laboratory findings indicate a low total body iron and hemoglobin levels along with clinical manifestations such as glossitis, cheilitis, and pallor.

The nurse reviews a patient's assessment findings, which include arthralgia, liver enlargement, and total body iron level of 70 g. The nurse would anticipate providing care related to which condition? a. Polycythemia b. Hemochromatosis c. Sickle cell disease d. Iron-deficiency anemia

d. Hyperpigmentation Common integumentary changes observed in anemia include pallor, pruritus, and jaundice. Pallor results from reduced amounts of hemoglobin and reduced blood flow to the skin. Pruritus occurs because of increased serum and skin bile salt concentration. Jaundice occurs when hemolysis of red blood cells (RBCs) results in an increased concentration of serum bilirubin. Hyperpigmentation is usually not associated with anemia.

The nurse reviews documentation of assessment findings of a patient with severe anemia. Which assessment finding would the nurse question? a. Pallor b. Pruritus c. Jaundice d. Hyperpigmentation

a. Increased cobalamin levels c. Increased hemoglobin levels d. Increased red blood cell levels f. Increased white blood cell levels Polycythemia vera has increased cobalamin and hemoglobin levels, as well as the presence of increased red blood cell and white blood cell levels. Elevated levels of histamine and blood platelet count are seen in patients with polycythemia vera.

The nurse suspects that a patient has polycythemia vera based on which findings in the patient' s laboratory reports? Select all that apply. a. Increased cobalamin levels b. Decreased histamine levels c. Increased hemoglobin levels d. Increased red blood cell levels e. Decreased blood platelet levels f. Increased white blood cell levels

a. Bilirubin d. Body temperature Choledocholithiasis is manifested by jaundice caused by elevated levels of bilirubin, fever, and chills. Creatinine levels are elevated in kidney diseases. The platelet count is increased in allergic reactions, infection, and splenectomy. The alkaline phosphatase level is elevated in liver diseases.

The nurse suspects that a patient with cholelithiasis has developed choledocholithiasis. Increases in which assessment finding would support the nurse's suspicion? Select all that apply. a. Bilirubin b. Creatinine c. Platelet count d. Body temperature e. Alkaline phosphatase

c. Lungs With repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially the spleen, lungs, kidneys, and brain. Organs that have a need for large amounts of O , like the lungs, are most often affected and form the basis for many of the complications of sickle cell disease (SCD). Although the liver, heart, and stomach may be affected, they are less so when compared to the lungs.

The nurse understands that with repeated episodes of sickling, which organ is most affected? a. Liver b. Heart c. Lungs d. Stomach

b. 1045 As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction, it is not necessary to remain at the bedside for longer than 15 minutes.

The nurse will begin a patient's transfusion of packed red blood cells at 1030. The nurse would plan to stay in the patient's room until which time? a. 1040 b. 1045 c. 1050 d. 1055

c. Another registered nurse (RN) Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. If there is not another nurse available, a health care provider could check the blood with the nurse. The unit secretary, physician's assistant, and UAP are not licensed to perform this duty.

The nurse would ask which health care team member to assist when checking a unit of packed red blood cells before administration? a. The unit secretary b. The physician's assistant c. Another registered nurse (RN) d. The unlicensed assistive personnel (UAP)

a. Initiate seizure precautions. SIADH is a disorder in which there is abnormally high production of antidiuretic hormone (ADH). Dilutional hyponatremia is a characteristic of SIADH and can cause seizures, nausea and vomiting, muscle cramps, and decreased neurologic function. The patient's head should be kept flat or elevated no higher than 10 degrees to enhance venous return to the heart and increase left atrial filling pressure, which all help to reduce ADH release. Fluid restrictions of 1000 mL or less need to be maintained. A hypertonic IV solution may be administered if the sodium level is less than 120 mEq/L.

The nurse would implement which nursing action when caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Initiate seizure precautions. b. Elevate the patient to a semi-Fowler's position. c. Increase fluid intake to at least 1500 mL/24 hours. d. Infuse prescribed hypotonic IV solution, such as 0.45% saline.

c. Heartburn d. Black stools e. Constipation Because the gastrointestinal (GI) tract excretes excess iron, the primary side effects of oral iron preparations are heartburn, black stools, and constipation. Anorexia is not an expected side effect. Red stool is not a side effect of iron preparation but can be caused by the presence of fresh blood in the stools due to bleeding from hemorrhoids or irritable bowel syndrome.

The nurse would instruct the patient about which side effects of oral iron supplements? Select all that apply. a. Anorexia b. Red stools c. Heartburn d. Black stools e. Constipation

c. Hemorrhage The major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in the blood, which results in excessive bleeding. Fatigue, weakness, and abdominal pain are minor complications of thrombocytopenia.

The nurse would monitor a patient with thrombocytopenia for which major complication? a. Fatigue b. Weakness c. Hemorrhage d. Abdominal pain

c. Platelet transfusion Administration of platelets or platelet transfusion is contraindicated in a patient who has TTP because it leads to new von Willebrand factor (vWF)-platelet complexes and increased clotting. Plasmapheresis supplies the appropriate vWF and enzyme (ADAMTS13) and removes large vWF molecules that bind with platelets; therefore it reverses the platelet consumption in the patient. Rituximab and corticosteroids are used in the treatment of TTP.

The nurse would question which therapy that is listed on a treatment plan for a patient who has thrombotic thrombocytopenic purpura (TTP)? a. Plasmapheresis b. Rituximab therapy c. Platelet transfusion d. Corticosteroid therapy

d. Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet. The patient's identifying information (name, date of birth, medical record number) on the identification bracelet should match exactly the information on the blood-bank tag that has been placed on the unit of blood. A second registered nurse should perform this check. If any information does not match, the transfusion should not be hung because of possible error and risk to the patient. Blood tubing, not primary tubing, is needed for blood transfusion and should not be administered as a secondary infusion. The nurse should remain with the patient for 15 minutes following initiation of transfusion.

The nurse would take which action to ensure patient safety when administering a unit of packed red blood cells (PRBCs)? a. Add the blood transfusion as a secondary line to the existing IV and infuse over 60 minutes or less. b. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of transfusion reaction. c. Select a new primary IV tubing to use for the administration and piggyback with 500 mL of normal saline. d. Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet.

b. Clean the bathroom and commode thoroughly. d. Ask your son to wash his hands thoroughly after using the bathroom. e. Ask all family members to wash their hands thoroughly before eating and after using the bathroom. Hepatitis A spreads through the fecal-oral route. Transmission is prevented by maintaining hygiene and thorough cleaning of the bathroom and all the equipment. Proper handwashing is extremely important in preventing the spread of the virus. Buying a separate commode is unnecessary. Using disposable toilet sheets is not sufficient to prevent spread of the virus.

The parent of a pediatric patient who has hepatitis A is worried about the spread of infection to other family members through using the same bathroom. Which information would the nurse provide to the patient's parent? Select all that apply. a. Buy a separate commode for your son. b. Clean the bathroom and commode thoroughly. c. There is no need for concern; just use disposable toilet covers. d. Ask your son to wash his hands thoroughly after using the bathroom. e. Ask all family members to wash their hands thoroughly before eating and after using the bathroom.

d. To block the sympathetic nervous system response to excess thyroid hormone Thyrotoxicosis is an acute crisis state of hyperthyroidism often precipitated by a physiologic stressor in the patient with hyperthyroidism. Thyrotoxicosis is an extreme state of hypermetabolism. Excessive amounts of thyroid hormone are present and tissue sensitivity to sympathetic nervous system stimulation is increased, resulting in a number of signs and symptoms, including severe tachycardia leading to heart failure. Propranolol is a β-adrenergic antagonist that blocks the thyroid hormone-induced sympathetic nervous system stimulation, resulting in a lowered heart rate and a decreased risk of heart failure. One of the priority treatment goals in the patient with thyrotoxicosis is to decrease thyroid hormone secretion. A decrease in thyroid hormone secretion is primarily accomplished through the use of either methimazole or propylthiouracil. Propranolol does not suppress thyroid hormone secretion. In addition to slowing heart rate, propranolol decreases BP; it is not used to prevent hypotension. Nonradioactive strong iodine solution, either in the form of saturated solution of potassium iodine or Lugol's solution, may be used to decrease the size and vascularity of the thyroid gland in preparation for surgery. Potassium iodide or Lugol's solution also may inhibit thyroid hormone synthesis. Propranolol does not decrease size or vascularity of the thyroid gland.

The patient experiencing thyrotoxicosis asks the nurse why he or she is being given propranolol. Which answer is accurate when responding to the patient' s question? a. To suppress thyroid hormone secretion b. To prevent thyroid hormone-induced hypotension c. To decrease thyroid gland vascularity in preparation for surgery d. To block the sympathetic nervous system response to excess thyroid hormone

c. "If I notice a fast heart rate or irregular beats, that is normal for cirrhosis." If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider because this is not normal for cirrhosis and is potentially dangerous. A scrotal support may improve comfort if there is scrotal edema. Edematous tissue is subject to breakdown and needs meticulous skin care. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency.

The patient with cirrhosis is learning self-care. Which statement indicates that the patient needs more teaching? a. "A scrotal support may be more comfortable when I have scrotal edema." b. "I need to take good care of my belly and ankle skin where it is swollen." c. "If I notice a fast heart rate or irregular beats, that is normal for cirrhosis." d. "I can use pillows to support my head to help me breathe when I am in bed."

c. Eltrombopag Eltrombopag (thrombopoietin receptor antagonist) increases platelet production and is therefore beneficial for this patient. Lepirudin is a direct thrombin inhibitor, which is beneficial for the treatment of heparin-induced thrombocytopenia (HIT). Vincristine is a chemotherapeutic agent, which is used in the treatment of thrombotic thrombocytopenic purpura (TTP). Fondaparinux is an indirect thrombin inhibitor and is used for the treatment of HIT.

The platelet count of a patient with chronic immune thrombocytopenic purpura (ITP) has decreased despite immunoglobulin and immunosuppressant drug therapy. The patient is not a candidate for a splenectomy. Which medication would the nurse anticipate incorporating into the patient's plan of care? a. Lepirudin b. Vincristine c. Eltrombopag d. Fondaparinux

c. Proliferation of immature white blood cells (WBCs) d. Replacement of bone marrow with blast cells a. Reduction in erythrocyte, leukocyte, and platelet count b. Occurrence of anemia, pallor, and infection In leukemia, immature white blood cells, such as malignant and blast cells, proliferate. Blast cells replace bone marrow resulting in bone marrow failure, which causes a decrease in red blood cells (RBCs), WBCs, and platelets. Anemia and pallor occur due to reduction in RBC count. The decrease in WBC count leads to immunosuppression, resulting in infection.

The steps involved in the pathophysiology of leukemia occur in which chronologic order? a. Reduction in erythrocyte, leukocyte, and platelet count b. Occurrence of anemia, pallor, and infection c. Proliferation of immature white blood cells (WBCs) d. Replacement of bone marrow with blast cells

a. Lumbar puncture e. CT Lumbar puncture and CT are used to detect leukemic cells outside of the blood and bone marrow. Morphologic study, histochemical study, and cytogenetic method are used to identify leukemic cell type and help in choice of chemotherapy regimen and other treatments.

To determine whether a patient's leukemia has affected other organs besides bone marrow and blood, which diagnostic studies will be prescribed? Select all that apply. a. Lumbar puncture b. Morphologic study c. Histochemical study d. Cytogenetic method e. CT

a. Monitor the patient for liver problems. c. Evaluate the patient's response to the therapy. e. Continue the supplementation for two to three months after hemoglobin levels return to normal. Long-term iron supplementation can cause liver dysfunction; therefore the patient should be evaluated for liver function abnormalities. While undergoing therapy, the nurse should evaluate the improvement in hemoglobin levels during every visit and should take necessary steps if hemoglobin levels do not improve. Iron therapy should be continued for two to three months after hemoglobin levels return to normal to replenish the iron stores in the body. Iron therapy is not associated with psychologic problems; hence, there is no need to monitor for psychologic changes. Iron supplementation should not be stopped once hemoglobin levels are back to normal.

To ensure maximum effectiveness of lifelong iron supplementation therapy, which intervention would the nurse include in the patient's plan of care? Select all that apply. a. Monitor the patient for liver problems. b. Assess the patient for psychologic problems. c. Evaluate the patient's response to the therapy. d. Discontinue the therapy after hemoglobin levels return to normal. e. Continue the supplementation for two to three months after hemoglobin levels return to normal.

d. 0.9% normal saline The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure that the patient receives blood that is left in the tubing when the bag is empty. 3% normal saline, Lactated Ringer's and 5% dextrose in water, are not compatible with blood products.

To prepare for a patient's transfusion of packed red blood cells, the nurse would select which IV solution to use for the procedure? a. 3% normal saline b. Lactated Ringer's c. 5% dextrose in water d. 0.9% normal saline

c. Molecular remission Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Partial remission is the condition in which there is a lack of symptoms of the disease and a normal peripheral blood smear but evidence of disease in the bone marrow. Complete remission is the condition in which the bone marrow and the peripheral blood appear normal. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination but can be detected by molecular testing.

When a leukemia patient's post-chemotherapy molecular studies are negative for residual leukemia, which type of remission has the patient achieved? a. Partial remission b. Complete remission c. Molecular remission d. Minimal residual disease

b. Hypercalcemia c. Hypoalbuminemia d. Reed-Sternberg cells Blood studies may show hypercalcemia from bone involvement and hypoalbuminemia if there is liver involvement for a patient with Hodgkin's lymphoma. Reed-Sternberg cells are giant lymphocytes that are characteristic of Hodgkin's lymphoma. Anemia is sometimes seen in Hodgkin's lymphoma, but polycythemia would not be expected. Bence Jones proteins are characteristic of multiple myeloma.

When a patient has Hodgkin's lymphoma that involves the bone and the liver, which diagnostic findings will the nurse expect? Select all that apply. a. Polycythemia b. Hypercalcemia c. Hypoalbuminemia d. Reed-Sternberg cells e. Bence Jones protein

c. MRI An MRI scan is useful in NHL to determine whether there is CNS involvement. Peripheral blood analysis might be used to check for complications such as anemia, thrombocytopenia, or liver involvement but would not be useful in detecting CNS involvement. Bone marrow aspiration might be done to detect bone marrow involvement but would not help to detect CNS involvement. A PET scan with CT is used to stage NHL and to assess the response to therapy.

When a patient has been diagnosed with non-Hodgkin's lymphoma (NHL), which diagnostic test will be used to assess for central nervous system (CNS) involvement? a. Peripheral blood analysis b. Bone marrow aspiration c. MRI d. Positron emission tomography (PET) scan

d. Taking the tablet with orange juice e. Taking the tablet an hour before meals Taking iron tablets an hour before food ensures maximum absorption because iron will not get bound to food. When iron binds with food, absorption of iron falls. Orange juice and ascorbic acid enhance iron absorption. Taking iron tablets with food can reduce iron absorption. Taking iron tablets before or after exercise does not affect absorption.

When a patient is prescribed iron tablets for the treatment of anemia, which measures ensure maximum absorption? Select all that apply. a. Taking the tablet with food b. Taking the tablet after exercise c. Taking the tablet before exercise d. Taking the tablet with orange juice e. Taking the tablet an hour before meals

b. Stop the blood transfusion. Itching and hives indicate that the patient is experiencing a blood transfusion reaction. The transfusion should be discontinued immediately and disconnected in order to minimize complications of the transfusion reaction. An infusion of normal saline may be started after the blood transfusion has been discontinued and disconnected. After the transfusion has been stopped, the nurse will assess the patient, including assessing BP and then notifying the health care provider. The antihistamine may be given to relieve itching and hives after the blood is discontinued and disconnected.

When a patient receiving a transfusion of packed red blood cells reports itching and develops hives on the chest and abdomen, which action will the nurse take first? a. Infuse normal saline. b. Stop the blood transfusion. c. Take the patient's BP. d. Give the prescribed antihistamine.

d. Superior vena cava syndrome Enlarged intrathoracic lymph nodes may place pressure on the superior vena cava and cause superior vena cava syndrome. Paraplegia may occur with compression of the lower spinal cord by enlarged nodes. Liver dysfunction may occur with spread to the liver, which would occur more commonly with lymph node involvement below the diaphragm. Renal dysfunction can occur if enlarged nodes place pressure on urinary tract structures.

When a patient with Hodgkin's lymphoma has mediastinal node involvement, the nurse will monitor for which complication? a. Paraplegia b. Liver dysfunction c. Renal dysfunction d. Superior vena cava syndrome

a. Partial remission Partial remission is a condition in which there is a lack of symptoms of the disease and a normal peripheral blood smear but evidence of the disease in the bone marrow. Complete remission refers to the condition in which the bone marrow and the peripheral blood appear normal. Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Minimal residual disease refers to the tumor cells that cannot be detected by morphologic examination but can be detected by molecular testing.

When a patient with leukemia has completed induction therapy with resolution of leukemia symptoms, normal peripheral blood smear testing, and some leukemic cells in the bone marrow testing, how will the patient's status be described? a. Partial remission b. Complete remission c. Molecular remission d. Minimal residual disease

c. Lymph node excisional biopsy A lymph node excisional biopsy is needed in NHL to determine the cell type and pattern, which guides the choice of treatment regimens. An upper endoscopy may be done to assess for gastrointestinal involvement but will not be useful in determining cell type or pattern. CT will show how far the NHL has progressed and is used for staging but is not as helpful in determining choice of chemotherapy. MRI will be helpful for staging of NHL and detecting central nervous system involvement but is not as useful for determining which chemotherapy regimen will be most effective.

When a patient with non-Hodgkin's lymphoma (NHL) is being evaluated to determine what type of chemotherapy regimen will be used, which test will be the most helpful? a. Upper endoscopy b. CT c. Lymph node excisional biopsy d. MRI

c. Evaluates the patient using the Glasgow Coma Scale (GCS) During the disability phase, a brief neurologic assessment is conducted using the GCS. Clothing is removed during the phase of "Exposure and Environmental Control." The patient's airway is initially assessed in the phase "Alertness and Airway." The presence of family is considered during the phase of "Facilitate Adjuncts and Family."

When caring for a patient with a life-threatening injury, the nurse takes which action during the disability phase of the primary survey? a. Removes all clothing from the patient b. Assesses the patient's airway and breathing c. Evaluates the patient using the Glasgow Coma Scale (GCS) d. Encourages the presence of the family during treatment

a. Acute lymphocytic leukemia (ALL) Acute lymphocytic leukemia is associated with hypercellular bone marrow with lymphoblasts (immature lymphocytes). Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts (immature myelocytes). Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs as a result of the excessive development of mature granulocytes in the bone marrow.

When diagnostic testing shows hypercellular bone marrow with lymphoblasts, the nurse expects the patient to be diagnosed with which type of leukemia? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)

d. Hematopoietic stem cell transplantation (HSCT) HSCT may be used to achieve a cure for Hodgkin's lymphoma once chemotherapy has achieved a remission. Corticosteroids may be part of the chemotherapy regimen but are not used alone to treat lymphoma or as maintenance therapy after remission is achieved. Targeted radiation therapy may be part of the initial treatment but is not needed once remission has been received. Maintenance chemotherapy does not contribute to survival once remission has been achieved for Hodgkin's lymphoma.

When initial treatment for stage III Hodgkin's lymphoma has been successful and the patient is in remission, the nurse anticipates that which type of therapy may be prescribed to follow the initial treatment? a. Corticosteroids b. Targeted radiation c. Maintenance chemotherapy d. Hematopoietic stem cell transplantation (HSCT)

a. "Have you experienced numbness or tingling of the feet?" Assessment of the cognitive-perceptual functional health pattern will include sensory data, such as numbness of the feet. The other questions also will help collect important data but are not directed toward sensory, cognitive, or perceptual patient information. Past health history of chemotherapy may help to determine whether the patient is having a relapse of leukemia. Knowledge about gum bleeding or oral pain is collected as part of the nutritional-metabolic functional health pattern and will help the nurse plan diet and oral care for this patient. Family history of leukemia or cancer may help to determine what type of leukemia the patient has and what treatment will be best and falls in the health perception-health management functional health pattern.

When interviewing a patient with leukemia, which question would the nurse ask to obtain information about the patient's cognitive-perceptual functional health pattern? a. "Have you experienced numbness or tingling of the feet?" b. "Do you have any past history of chemotherapy for cancer?" c. "Have you noticed any gum bleeding or oral pain recently?" d. "Is there any family history of leukemia or other cancers?"

d. Superior vena cava syndrome Enlarged mediastinal lymph nodes may lead to compression of the superior vena cava; the nurse will assess for neck vein distension, facial and upper extremity swelling, cough, and dyspnea. Bone pain may occur with Hodgkin's lymphoma but is not necessarily associated with mediastinal node enlargement. Paraplegia may occur with spinal cord compression but would occur with nodal enlargement below the diaphragm. Renal failure may occur with hypercalcemia secondary to bone involvement but would not be typically associated with mediastinal lymphadenopathy.

When positron emission tomography (PET) for a patient with Hodgkin's lymphoma shows enlarged mediastinal lymph nodes, the nurse will plan to assess for which complication? a. Bone pain b. Paraplegia c. Renal failure d. Superior vena cava syndrome

b. Complete remission In complete remission, the bone marrow and the peripheral blood appear normal. The patient does not show any evidence of disease upon physical examination. Partial remission is a condition characterized by a lack of disease symptoms and a normal peripheral blood smear, but evidence of disease remains in the bone marrow. Molecular remission is the condition in which all molecular studies are negative for residual leukemia. Minimal residual disease indicates that tumor cells cannot be detected by morphologic examination but can be detected by molecular testing.

When the posttreatment diagnostic studies for a patient with leukemia indicate normal bone marrow and peripheral blood, and the physical examination does not show any evidence of disease, which term will be used to describe the patient's status? a. Partial remission b. Complete remission c. Molecular remission d. Minimal residual disease

c. Irreversible renal failure TTP causes irreversible renal failure because of prolonged vasoconstriction if left untreated in a patient. Venous thrombosis is observed in heparin-induced thrombocytopenia (HIT). Acute hemarthrosis is a complication of hemophilia. Decreased platelet production is the cause of immune thrombocytopenic purpura (ITP).

When thrombotic thrombocytopenic purpura (TTP) is left untreated, the nurse identifies that the patient is at risk for which complication? a. Venous thrombosis b. Acute hemarthrosis c. Irreversible renal failure d. Decreased platelet production

d. Provide continuous electrocardiogram (ECG) monitoring. The nurse will implement continuous ECG monitoring during the primary survey for a patient with abdominal trauma. It is not necessary to insert an orogastric tube, as there is no indication of significant head or facial trauma. Two large-bore IVs are inserted into patients with symptoms of shock or hypotension. Bilateral BPs are obtained for patients suspected of or who have sustained chest trauma or if the BP is abnormal.

Which action does the nurse implement during the primary survey for a patient with abdominal trauma? a. Insert an orogastric tube. b. Initiate two large-bore IVs. c. Obtain bilateral BPs. d. Provide continuous electrocardiogram (ECG) monitoring.

d. Blood oozing from venipuncture sites Bleeding in a person with no previous history or obvious cause should be questioned because it may be one of the first manifestations of acute DIC. The patient will not have bradypnea or wheezing. Tachycardia and hypotension are found in patients with DIC (not bradycardia and hypertension).

Which assessment finding may indicate the development of disseminated intravascular coagulation (DIC) in a patient who experienced an anaphylactic reaction? a. Scattered wheezes b. Increasing bradypnea c. Bradycardia and hypertension d. Blood oozing from venipuncture sites

b. Infuse the FFP as rapidly as the patient will tolerate. The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in Factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused unless a second IV line has been started for the transfusion.

Which action is appropriate for the nurse to take when infusing fresh frozen plasma (FFP)? a. Administer the FFP over four hours. b. Infuse the FFP as rapidly as the patient will tolerate. c. Infuse the FFP as a piggyback to a primary solution of normal saline. d. Administer the FFP as a piggyback to the primary IV solution.

b. Eating three large meals a day Patients with pancreatitis should be given small and frequent meals to reduce or prevent pancreatic stimulation. Therefore avoiding small, frequent meals is responsible for the patient's condition. Pancreatitis is associated with fatty and foul-smelling stools; monitoring of stools is required in patients with this disease. Omeprazole is an antisecretory agent used for reducing gastric acid in the stomach; it is given after meals to increase its duration of action. Pancreatic enzyme supplements are to be taken along with meals or snacks.

Which action is likely to exacerbate the condition of a patient who has pancreatitis? a. Checking for fatty stools b. Eating three large meals a day c. Taking omeprazole one hour after meals d. Taking pancreatic enzymes along with meals

b. Arrange for a group discussion to allow staff to verbalize feelings and emotions. A critical incident stress management session involves a group discussion to allow staff to verbalize feelings and emotions. A chaplain can come as part of the discussion on providing end-of-life care to help the staff resolve their feelings and emotions, but the focus is debriefing and sharing of feelings. While individual staff members may need assistance from the EAP provider in resolving feelings caused by the MCI, a critical incident stress management session is a group discussion by staff members involved in the MCI. An online educational program will not be helpful in resolving emotions associated with the MCI.

Which action will the nurse manager take after identifying the need for a critical incident stress management session following a mass casualty incident (MCI)? a. Ask the hospital chaplain to discuss death and best practices for end-of-life care. b. Arrange for a group discussion to allow staff to verbalize feelings and emotions. c. Schedule staff for days off to visit the employee assistance program (EAP) provider. d. Offer an online educational program on disasters in the emergency department (ED).

a. Carefully monitor intake and output measurements. Tumor lysis syndrome is a common complication of chemotherapy for Burkitt's NHL, and the nurse will plan to administer IV fluids and monitor intake and output carefully to prevent and detect this complication. Antibiotic therapy will not be administered for Burkitt's NHL unless the patient develops an infection. There is no need to assess grip strength or neurologic status more frequently. Although Hodgkin's lymphoma has an 80% long-term survival level with treatment, NHL has a much poorer prognosis.

Which action would the nurse plan to take when a patient is being treated with chemotherapy for Burkitt's non-Hodgkin's lymphoma (NHL)? a. Carefully monitor intake and output measurements. b. Administer concurrent IV antibiotics. c. Check grip strength and orientation more frequently. d. Teach the patient that there is an 80% chance of survival.

b. Infuse the blood slowly for the first 15 minutes of the transfusion. Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse initially should infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging a unit of blood. Only one unit of blood can be picked up at a time, must be infused within four hours, and cannot be hung with dextrose.

Which action would the nurse take to prevent an adverse effect when administering two units of blood to a patient? a. Immediately obtain both units of blood from the blood bank. b. Infuse the blood slowly for the first 15 minutes of the transfusion. c. Regulate the flow rate so that each unit takes at least four hours to transfuse. d. Prepare a solution of dextrose in water to be administered after the transfusion is complete.

a. Monitoring the pupillary response b. Elevating the head of the patient's bed c. Observing the patient for any signs of bleeding e. Monitoring extremity strength to detect neurologic complications Monitoring the pupillary response helps to rule out any visual changes after transsphenoidal hypophysectomy. Observing the patient for signs of bleeding is of the utmost importance, as hemorrhage can cause complications. The strength of the extremities is monitored to rule out postoperative neurologic complications, such as ataxia. Elevating the head of the patient's bed to a 30-degree angle alleviates pressure on the sella turcica and decreases headaches, which are a frequent postoperative problem. Avoiding tooth brushing for at least 10 days helps to protect the suture line.

Which actions would the nurse take when caring for a patient status post a transsphenoidal hypophysectomy? Select all that apply. a. Monitoring the pupillary response b. Elevating the head of the patient's bed c. Observing the patient for any signs of bleeding d. Advising the patient to brush his or her teeth twice daily e. Monitoring extremity strength to detect neurologic complications

a. Gums for bleeding Cholecystitis is associated with decreased production of prothrombin, a clotting factor, thereby putting the patient at risk of bleeding. Common bleeding sites are mucous membranes of the gums, mouth, and nose, as well as injection sites. A patient with cholecystitis does not show alterations in blood glucose levels. Asterixis is a finding common in hepatic encephalopathy and would not be expected with cholecystitis. A patient with cholecystitis does not show alterations in serum creatinine levels.

Which aspect would the nurse monitor for in a patient who has cholecystitis? a. Gums for bleeding b. Blood glucose levels c. Presence of asterixis d. Serum creatinine levels

c. Jaundice ALL can affect organs such as the liver and the spleen. When leukemic cells infiltrate the liver, it can cause impaired function and jaundice, as bilirubin metabolism is impaired. Fever and bone pain are related to increased lymphocyte production. Pallor is related to decreased red blood cell production.

Which assessment finding indicates possible hepatic involvement in a patient newly diagnosed with acute lymphocytic leukemia (ALL)? a. Fever b. Pallor c. Jaundice d. Bone pain

a. Pallor The integumentary finding of pallor is associated with severe anemia. Gastrointestinal diarrhea is not associated with anemia. Cardiovascular palpitations are associated with mild anemia. Pulmonary exertional dyspnea is associated with mild anemia.

Which assessment finding would the nurse associate with severe anemia? a. Pallor b. Diarrhea c. Palpitations d. Exertional dyspnea

b. Asterixis Asterixis is a twitching spasm of the hands and wrists seen in patients with increased ammonia levels in conditions such as hepatic encephalopathy. Aphasia, hyperactivity, and acute dementia are manifestations not associated with hepatic encephalopathy. Besides asterixis, an increased serum ammonia level causes sedation and confusion that progress to a comatose state.

Which assessment finding would the nurse expect in a patient with a high ammonia level associated with hepatic encephalopathy? a. Aphasia b. Asterixis c. Hyperactivity d. Acute dementia

c. Blast cells remaining in the bone marrow In partial remission, symptoms are absent and the blood smear is normal, but abnormal cells remain in the bone marrow. A patient who reports ongoing chronic fatigue would not meet the criteria for partial remission since ongoing fatigue is a symptom of leukemia. A patient with abnormalities in the peripheral blood smear would not meet the criteria for partial remission since peripheral blood smears are normal in partial remission. A patient with negative molecular studies for residual leukemia would more likely be in complete remission since these studies indicate that no evidence of leukemic cells remains.

Which assessment finding would the nurse expect when caring for a patient who has achieved partial remission after the initial prescribed chemotherapy for acute leukemia? a. Patient report of chronic fatigue b. Abnormalities in the peripheral blood smear c. Blast cells remaining in the bone marrow d. Negative molecular studies for residual leukemia

d. Clay-colored stools The presence of gallstones results in bile flow obstruction, which is manifested by fever, clay-colored stools, and dark urine. Tachycardia and hypotension are the clinical manifestations of acute pancreatitis. Hyperglycemia is seen in patients with chronic pancreatitis.

Which assessment finding would the nurse expect when caring for a patient who has gallstones? a. Tachycardia b. Hypotension c. Hyperglycemia d. Clay-colored stools

a. Pedal edema c. Mental status changes d. Black, tarry stools Complications of cirrhosis of the liver include peripheral edema, gastric varices, and hepatic encephalopathy. Peripheral edema presents itself as swelling/edema of the feet, or pedal edema. Hepatic encephalopathy presents as disorientation, altered mental status, sleep disturbance, and lethargy. Gastric varices bleed easily. This bleeding can present as blood in vomitus or blood in the stool. Cirrhosis doesn't typically cause chest pain, diaphoresis, or productive cough.

Which assessment findings are associated with complications of cirrhosis of the liver? Select all that apply. a. Pedal edema b. Productive cough c. Mental status changes d. Black, tarry stools e. Chest pain with diaphoresis

a. Dilated pupils b. Tachycardia Prolonged exposure to heat over hours or days leads to heat exhaustion. This is a clinical syndrome characterized by fatigue, nausea, vomiting, extreme thirst, and feelings of anxiety. Tachycardia and dilated pupils are present. Hypotension and ashen color, not hypertension and flushed skin, are also present. Muscle contractions occur in the exerted muscles of a patient with heat cramps.

Which assessment findings are associated with heat exhaustion? Select all that apply. a. Dilated pupils b. Tachycardia c. Hypertension d. Flushed skin e. Muscle contractions

b. Increased reticulocytes c. Decreased hemoglobin TTP is characterized by hemolytic anemia, which increases reticulocytes because of bleeding. Hemoglobin is decreased in TTP because of bleeding. The laboratory reports that a patient with TTP will show decreased haptoglobin, increased schistocytes, and increased indirect bilirubin.

Which assessment findings indicate that a patient may be experiencing thrombotic thrombocytopenic purpura (TTP)? Select all that apply. a. Increased haptoglobin b. Increased reticulocytes c. Decreased hemoglobin d. Decreased schistocytes e. Decreased indirect bilirubin

b. Petechiae The nurse assesses parameters such as petechiae and injection sites to determine the signs of external bleeding. The nurse should assess other parameters such as heart rate, mental status, and abdominal girth to determine the signs of internal bleeding.

Which assessment would the nurse perform to determine the presence of external bleeding? a. Heart rate b. Petechiae c. Mental status d. Abdominal girth

a. The presence of a brain tumor Brain tumor is one possible cause for central diabetes insipidus, which occurs due to the interference with antidiuretic hormone synthesis, transport, or release. In cases of renal damage and drug therapy with lithium, there would be an inadequate renal response to antidiuretic hormone despite the presence of adequate antidiuretic hormone, which leads to nephrogenic diabetes insipidus. A structural lesion in the thirst center may cause primary diabetes insipidus, which can be a result of excessive water intake.

Which cause is associated with central diabetes insipidus? a. The presence of a brain tumor b. Renal damage from long-standing hypertension c. Drug therapy with lithium for bipolar disorder d. Structural lesion in the thirst center

b. Bleomycin The most common chemotherapeutic regimen prescribed for early stage Hodgkin's lymphoma is doxorubicin ( Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD regimen). Rituximab is used in treatment of non-Hodgkin's lymphoma and multiple other hematologic disorders but is not used to treat Hodgkin's lymphoma. Fludarabine is a chemotherapeutic agent used in non-Hodgkin's lymphoma and leukemia. Ibritumomab tiuxetan is used in treatment of non-Hodgkin's lymphoma.

Which chemotherapeutic medication will the nurse anticipate administering for a patient with stage IA Hodgkin ' s lymphoma? a. Rituximab b. Bleomycin c. Fludarabine d. Ibritumomab tiuxetan

a. High fever c. Leukocytosis e. Abdominal pain A pancreatic abscess is a collection of pus and manifests with symptoms of infection, such as high fever, leukocytosis, and abdominal pain. Steatorrhea is associated with chronic pancreatitis. Chvostek's sign, associated with hypocalcemia, is seen with acute pancreatitis.

Which clinical findings would be consistent with a patient developing a pancreatic abscess? Select all that apply. a. High fever b. Steatorrhea c. Leukocytosis d. Chvostek's sign e. Abdominal pain

a. Delusions Addison's disease occurs due to the hypofunction of adrenal cortex. This hypofunction manifests as delusions, which occur due to decreased levels of glucocorticoids. Hypokalemia, hyperglycemia, and truncal obesity are clinical manifestations of Cushing syndrome that occur due to hyperfunction of the adrenal cortex.

Which clinical manifestation is seen with Addison's disease? a. Delusions b. Hypokalemia c. Hyperglycemia d. Truncal obesity

a. Hepatomegaly d. Elevated liver enzymes Chronic hepatitis is manifested by hepatomegaly and elevated liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Fever, nausea, vomiting, and decreased sense of taste are associated with acute hepatitis.

Which clinical manifestations are seen with chronic hepatitis? Select all that apply. a. Hepatomegaly b. Low-grade fever c. Nausea and vomiting d. Elevated liver enzymes e. Decreased sense of taste

a. Coma b. Lethargy c. Confusion d. Headache If the plasma osmolality and serum sodium levels continue to decline below 120 mmol/L, cerebral edema may occur, leading to manifestations such as coma, lethargy, confusion, and headache. Tachycardia and hypovolemic shock are the complications of diabetes insipidus.

Which clinical manifestations of severe serum sodium level decline would the nurse assess in a patient who has cerebral edema associated with syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. a. Coma b. Lethargy c. Confusion d. Headache e. Tachycardia f. Hypovolemic shock

b. Dysrhythmias c. Systolic murmurs e. Systolic hypertension Graves' disease is a term used to describe hyperthyroidism. Clinical manifestations associated with this disease process include tachycardia, dysrhythmia, systolic murmurs, and systolic hypertension. Hypothyroidism is associated with bradycardia and distant heart sounds.

Which clinical manifestations would the nurse assess in a hospitalized patient diagnosed with Graves' disease? Select all that apply. a. Bradycardia b. Dysrhythmias c. Systolic murmurs d. Distant heart sounds e. Systolic hypertension

a. Tachypnea b. Increased appetite e. Bounding, rapid pulse Exophthalmos is a classic finding in Graves' disease, which is caused by hyperthyroidism. Clinical manifestations assessed by the nurse would include tachypnea, increased appetite, and a bounding, rapid pulse. These manifestations are related to the effect of excess circulating thyroid hormone. It directly increases metabolism and tissue sensitivity to sympathetic nervous system stimulation. Clinical symptoms such as slurred speech and distended abdomen are associated with hypothyroidism.

Which clinical manifestations would the nurse assess in a hospitalized patient experiencing exophthalmos? Select all that apply. a. Tachypnea b. Increased appetite c. Slurred speech d. Distended abdomen e. Bounding, rapid pulse

a. Increased thirst d. Increased urination Since growth hormone (GH) antagonizes the action of insulin leading to hyperglycemia, glucose intolerance and manifestations of diabetes mellitus might occur including polydipsia (increased thirst) and polyuria (increased urine output). Dysrhythmias, constipation, and tingling sensation of the hands are not clinical manifestations of diabetes mellitus.

Which clinical manifestations would the nurse document that correlate with the development of diabetes mellitus in a patient with a history of acromegaly? Select all that apply. a. Increased thirst b. Dysrhythmias c. Constipation d. Increased urination e. Tingling sensation of the hands

b. Stage IIIB Because lymph nodes both above and below the diaphragm are involved, the patient is in stage III of the disease. The letter A indicates the absence of systemic symptoms, and the letter B indicates their presence. Because the patient presents with systemic symptoms, such as fever, night sweats, and weight loss, the patient is in stage IIIB. If the patient did not have any systemic symptoms, the stage of the disease would have been stage IIIA. In stage IVA, other internal organs such as the liver would be involved but the patient would not be experiencing fever, night sweats, and weight loss. In stage IVB, internal organs such as the liver would be involved and the patient would report the B symptoms of fever, night sweats, and weight loss.

Which clinical stage of lymphoma will the nurse suspect for a patient who has enlarged mediastinal and retroperitoneal lymph nodes and reports fever, night sweats, and weight loss? a. Stage IIIA b. Stage IIIB c. Stage IVA d. Stage IVB

a. Diabetes mellitus Diabetes mellitus may occur if pheochromocytoma is left untreated. Graves' disease, Alzheimer's disease, and chronic kidney disease are not complications of pheochromocytoma.

Which complication may arise if pheochromocytoma is left untreated? a. Diabetes mellitus b. Graves' disease c. Alzheimer's disease d. Chronic kidney disease

d. Non-Hodgkin's lymphoma (NHL) Immunosuppression is a risk factor for NHL, and the nurse will screen for NHL, such as lymph node enlargement. Immunosuppression is not a risk factor for hemochromatosis. Increased risk for multiple myeloma does not occur with use of immunosuppressants. Immunosuppression is not a risk factor for polycythemia vera.

Which complication will the nurse assess for when caring for a clinic patient who takes an immunosuppressive medication after having a kidney transplant? a. Hemochromatosis b. Multiple myeloma c. Polycythemia vera d. Non-Hodgkin's lymphoma (NHL)

d. Renal failure High levels of calcium and uric acid caused by tumor lysis syndrome may lead to acute kidney injury (acute renal failure) in patients with NHL. Jaundice may occur with NHL due to spread to the liver but is not caused by tumor lysis syndrome. Bone pain may occur with NHL if there is bone involvement but is not related to tumor lysis syndrome. Paraplegia may occur in NHL if enlarged lymph tissue pushes on the spinal cord but is not caused by tumor lysis syndrome.

Which complication will the nurse monitor for when a patient with non-Hodgkin's lymphoma (NHL) develops tumor lysis syndrome? a. Jaundice b. Bone pain c. Paraplegia d. Renal failure

b. Infertility Hypophysectomy may result in permanent loss or deficiencies of follicle-stimulating hormone, luteinizing hormone, and thyroid hormones resulting in decreased fertility or infertility. Seizures and cerebral edema are possible complications for patients undergoing stereotactic radio surgery, not hypophysectomy. Transient diabetes insipidus, not diabetes mellitus, may occur following hypophysectomy.

Which complication would the nurse include in the teaching plan when educating a patient about possible postsurgical complications related to a hypophysectomy? a. Seizures b. Infertility c. Cerebral edema d. Transient diabetes mellitus

a. Fractures d. Osteoporosis e. Kidney stones Fractures may be seen due to an increase in parathyroid hormone secretion. It decreases bone density because it has an effect on osteoclastic and osteoblastic activity. Osteoporosis may occur due to deformation of bones. Kidney stones can occur due to an increase in calcium levels in the urine. Constipation, not diarrhea, is associated with hyperparathyroidism. Hypotension is not associated with hyperparathyroidism.

Which complications are associated with hyperparathyroidism? Select all that apply. a. Fractures b. Diarrhea c. Hypotension d. Osteoporosis e. Kidney stones

c. Diabetes mellitus Acalculous cholecystitis is an inflammatory process that occurs in the absence of obstruction and is associated with diabetes mellitus. Cholangitis and choledolithiasis are complications of cholelithiasis, not acalculous cholecystitis. Acute pancreatitis is not associated with acalculous cholecystitis.

Which condition is associated with acalculous cholecystitis? a. Cholangitis b. Choledolithiasis c. Diabetes mellitus d. Acute pancreatitis

b. Hypothyroidism A decrease in the level of thyroid hormone, evidenced by below-normal T and T levels and increased TSH, indicates hypothyroidism. TSH increases as the body attempts to compensate for decreased thyroid production by trying to stimulate more T and T production. Hypoparathyroidism is a decrease in parathormone that in turn causes a decrease in serum calcium. In hyperthyroidism, T and T production are increased and TSH is decreased. Hyperparathyroidism is an increase in parathormone that causes an increase in serum calcium.

Which condition is associated with decreased triiodothyronine (T ) and thyroxine (T ) levels and an increased TSH (thyroid-stimulating hormone) level? a. Hypoparathyroidism b. Hypothyroidism c. Hyperthyroidism d. Hyperparathyroidism

d. Pancreatic pseudocyst A pancreatic pseudocyst is an accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates surrounded by a wall. Biliary sludge is a mixture of cholesterol crystals and calcium salts. Biliary atresia is a congenital condition in which the bile duct is closed or absent. Pancreatic abscess is a collection of pus resulting from necrosis of the pancreas.

Which condition is associated with the accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates? a. Biliary sludge b. Biliary atresia c. Pancreatic abscess d. Pancreatic pseudocyst

a. Acromegaly In acromegaly, carpal tunnel syndrome may exist, which is characterized by feelings of numbness and discomfort in the thumb and fingers. Hypopituitarism leads to visual changes, loss of smell, and nausea and vomiting. Hyperthyroidism can be easily diagnosed by palpating the thyroid gland. Diabetes insipidus is mostly manifested by excessive thirst caused by frequent urination.

Which condition is associated with the symptoms of numbness and a " pins and needles " sensation in the thumb, middle, and index finger, especially at night? a. Acromegaly b. Hypopituitarism c. Hyperthyroidism d. Diabetes insipidus

c. Sickle cell disease Sickle cell disease is characterized by the presence of a high percentage of Hgb S in the erythrocytes. Thalassemia occurs due to the absence of reduced globulin protein. Aplastic anemia is a disease characterized by pancytopenia in which all the blood cell types decrease. Acquired hemolytic anemia results from hemolysis of red blood cells (RBCs) from extrinsic factors. It is characterized by increased mean corpuscular volume (MCV), reticulocytes, and bilirubin.

Which condition is characterized by the presence of a high percentage of hemoglobin S (Hgb S) in the erythrocytes? a. Thalassemia b. Aplastic anemia c. Sickle cell disease d. Acquired hemolytic anemia

a. Acute hemarthrosis Acute hemarthrosis is characterized by bleeding into the joint spaces, as is seen in hemophilia. Bleeding in the joints causes local inflammation. The image shows inflammation of the knee joint and is therefore acute hemarthrosis. Severe ecchymosis causes accumulation of waste blood due to hematomas. Therefore the image for severe ecchymosis will show red coloration on the body. HIT will show skin necrosis. Acute idiopathic thrombocytopenic purpura will show purplish petechiae.

Which condition is depicted in the figure? a. Acute hemarthrosis b. Severe ecchymosis c. Heparin-induced thrombocytopenia (HIT) d. Acute idiopathic thrombocytopenic purpura

b. HELLP syndrome HELLP syndrome is a life-threatening liver disorder thought to be a type of severe preeclampsia. It is characterized by hemolysis, elevated liver enzymes, and low platelet count. The HELLP syndrome is an obstetric condition that may predispose a pregnant patient to acute disseminated intravascular coagulation (DIC) disorder. A septic abortion is a form of miscarriage that is associated with a serious uterine infection. An abruptio placenta is the premature separation of the placenta from the uterus. Amniotic fluid embolism is an obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the maternal circulation, causing cardiopulmonary collapse.

Which condition is life-threatening and assumed to be a type of severe preeclampsia? a. Septic abortion b. HELLP syndrome c. Abruptio placentae d. Amniotic fluid embolism

a. Hyperaldosteronism Conn's syndrome is associated with the excessive production of aldosterone (hyperaldosteronism) by the adrenal glands. Conn's syndrome is characterized by high BP, headache, poor vision, and various complications. Hypoaldosteronism, hyperparathyroidism, and hypoparathyroidism may not be linked with Conn's syndrome.

Which condition may be linked to Conn's syndrome? a. Hyperaldosteronism b. Hypoaldosteronism c. Hyperparathyroidism d. Hypoparathyroidism

c. Folic acid deficiency Folic acid deficiency can cause the synthesis of defective DNA and result in anemia. A decreased number of red blood cell precursors results in anemia in patients with myelodysplasia and Fanconi syndrome. Increased red blood cell destruction can result in anemia in patients with G6PD enzyme deficiency.

Which condition results in anemia due to synthesis of defective deoxyribonucleic acid (DNA) in the body? a. Myelodysplasia b. Fanconi syndrome c. Folic acid deficiency d. G6PD enzyme deficiency

d. Hyperfunction of glucocorticoids Purplish red striae are seen in Cushing syndrome, which occurs due to excess corticosteroids, particularly glucocorticoids. In Addison's disease, all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and androgens) are reduced. A striking integumentary sign of Addison's disease is bronze-colored skin hyperpigmentation, not purplish red striae.

Which condition shows a clinical presentation of purplish red striae? a. Hypofunction of androgens b. Hyperfunction of androgens c. Hypofunction of glucocorticoids d. Hyperfunction of glucocorticoids

a. Gallstones b. Cystic fibrosis c. Alcohol abuse Pancreatitis is an inflammation of the pancreas. Gallstones and alcohol abuse are the causes of acute pancreatitis, while cystic fibrosis can cause chronic pancreatitis. Isoniazid therapy is associated with acute liver failure. Contamination of food by feces causes hepatitis.

Which conditions may cause pancreatitis? Select all that apply. a. Gallstones b. Cystic fibrosis c. Alcohol abuse d. Isoniazid therapy e. Food contamination

c. Bleeding disorder e. Low hemoglobin level A patient with bleeding disorder or a preprocedure low hemoglobin level may not be an appropriate candidate for liver biopsy due to the increased risk of postprocedure bleeding. A diagnosis of chronic hepatitis is not a reason to postpone a liver biopsy; in fact, it is an indication for liver biopsy. Hepatic cirrhosis or autoimmune hepatitis are not reasons to postpone a liver biopsy; the biopsy is being done to further diagnose or stage the disease.

Which conditions may require a patient's scheduled percutaneous liver biopsy to be rescheduled? Select all that apply. a. Chronic hepatitis b. Hepatic cirrhosis c. Bleeding disorder d. Autoimmune hepatitis e. Low hemoglobin level

c. To compensate for a hypermetabolic state Administering 100% oxygen to a patient with heatstroke compensates for the hypermetabolic state. The primary purpose of administering oxygen is not to prevent dysrhythmias. The oxygen does not increase cerebral blood flow or correct the effects of an electrolyte imbalance.

Which describes the primary purpose of administering 100% oxygen to a patient with heatstroke? a. To prevent dysrhythmias b. To increase cerebral blood flow c. To compensate for a hypermetabolic state d. To correct the effects of an electrolyte imbalance

c. Hodgkin's lymphoma Hodgkin's lymphoma is a malignant condition characterized by proliferation of abnormal giant, multinucleated cells called Reed-Sternberg cells, which are located in the lymph nodes. Polycythemia is characterized by an increased number of red blood cells. Multiple myeloma is characterized by the presence of Bence Jones protein in blood and urine. The presence of Reed-Sternberg cells helps to differentiate Hodgkin's lymphoma from non-Hodgkin's lymphoma.

Which diagnosis is confirmed by a biopsy showing Reed-Sternberg cells? a. Polycythemia b. Multiple myeloma c. Hodgkin's lymphoma d. Non-Hodgkin's lymphoma

c. Presence of Philadelphia chromosome The Philadelphia chromosome is present in 90% to 95% of patients with CML and is a diagnostic hallmark of CML. Thrombocytopenia may occur with CML, but thrombocytosis would not be expected. Since CML is characterized by abnormal myelocytes (not abnormal lymphocytes) and does not typically invade the central nervous system, lymphoblasts in the cerebrospinal fluid are not an expected finding. In CML, the bone marrow would contain abnormal but mature myelocytes.

Which diagnostic finding is a hallmark of chronic myelogenous leukemia (CML)? a. Thrombocytosis b. Lymphoblasts in cerebrospinal fluid c. Presence of Philadelphia chromosome d. Hypercellular bone marrow with lymphoblasts

d. Positron emission tomography (PET) PET is helpful to define all sites and determine the clinical stage of Hodgkin's lymphoma. Barium enemas would be used to help determine the impact of Hodgkin's lymphoma on lower gastrointestinal tract function. An upper endoscopy would be used to assess for the effect of lymphoma on upper gastrointestinal tract function. A CBC would be helpful in determining whether lymphoma has infiltrated the bone marrow.

Which diagnostic study is helpful in determining the clinical stage of Hodgkin's lymphoma? a. Barium enema b. Upper endoscopy c. Complete blood count (CBC) d. Positron emission tomography (PET)

c. Cancer-associated antigen 19-9 (CA 19-9) CA 19-9 is the tumor marker used for the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment. Although a spiral CT scan may be the initial study done and provides information on metastasis and vascular involvement, the CT and the PET/CT scan or abdominal ultrasound do not provide additional information.

Which diagnostic study is used to diagnose pancreatic adenocarcinoma and monitor the patient's response to treatment? a. Abdominal ultrasound b. Spiral CT scan c. Cancer-associated antigen 19-9 (CA 19-9) d. A positron emission tomography (PET)/CT scan

b. Bone marrow biopsy A bone marrow biopsy provides a sample to determine the presence of leukemic cells. Blood cultures are done to detect the presence of microorganisms, such as bacteria or fungi, in the blood. Blood cultures will not detect leukemic cells. An MRI creates a detailed image of the organs and tissues in the body but does not identify specific cell types. A Wood's lamp examination is usually done on the surface of the skin and can detect the presence of bacterial or fungal skin infections.

Which diagnostic test allows the health care provider to directly visualize the presence of leukemic cells? a. Blood culture b. Bone marrow biopsy c. MRI d. Wood's lamp examination

b. Bone marrow analysis When destruction of circulating platelets is the cause, bone marrow analysis shows megakaryocytes (precursors of platelets) to be normal or increased, even though circulating platelets are reduced. Hemoglobin measures the amount of protein in the red blood cells that carries oxygen to the body's organs and tissues and transports carbon dioxide from the organs and tissues back to the lungs. PT is used to assess secondary hemostasis. Peripheral blood smear is used to distinguish acquired disorders from congenital disorders.

Which diagnostic test can detect destruction of circulating platelets as the cause of thrombocytopenia? a. Hemoglobin b. Bone marrow analysis c. Prothrombin time (PT) d. Peripheral blood smear

b. Reed-Sternberg cells in the lymph node The presence of Reed-Sternberg cells in a lymph node biopsy specimen is the main diagnostic feature in Hodgkin's lymphoma disease. Lymphoblasts in the cerebrospinal fluid indicate acute lymphocytic leukemia. Hypercellular bone marrow with myeloblasts is a diagnostic finding of acute myelogenous leukemia. The Philadelphia chromosome is a sign of chronic myelogenous leukemia.

Which diagnostic test result indicates a diagnosis of Hodgkin's lymphoma? a. Lymphoblasts in the cerebrospinal fluid b. Reed-Sternberg cells in the lymph node c. Hypercellular bone marrow with myeloblasts d. Philadelphia chromosome in the bone marrow cells

b. Decreased platelets and red blood cells (RBCs) Since bone marrow proliferation of abnormal lymphocytes leads to decreased RBCs and thrombocyte production, the nurse will expect low numbers of RBCs and platelets. Low leukocyte alkaline phosphatase is associated with chronic myelogenous leukemia. Acute myelogenous leukemia is characterized by hypercellular bone marrow with myeloblasts. Increased numbers of immature myelocytes are found in patients with acute myelogenous leukemia.

Which diagnostic test result will the nurse expect for a patient who has been diagnosed with acute lymphocytic leukemia? a. Low leukocyte alkaline phosphatase b. Decreased platelets and red blood cells (RBCs) c. Hypercellular bone marrow with myeloblasts d. Elevated numbers of immature myelocytes

b. Serum lipase c. Serum amylase e. CT scan Serum amylase and lipase levels usually increase in acute pancreatitis due to pancreatic fibrosis. CT scan is used to confirm pancreatitis and its related complications. Liver biopsy is not indicated in pancreatitis because pancreatitis is not related to liver dysfunction. Serum α-fetoproteins are not related to pancreatitis; they are elevated in liver cancer.

Which diagnostic tests would the nurse anticipate will be prescribed to confirm a patient's diagnosis of acute pancreatitis? Select all that apply. a. Liver biopsy b. Serum lipase c. Serum amylase d. Serum α-fetoproteins e. CT scan

a. Eat a high-fiber diet. d. Have small but frequent meals. e. Avoid or keep fats to a minimum. Having a high-fiber diet helps in the smoother passage of stools and prevents constipation. Having small and frequent meals helps digestion and prevents nausea. Fats are harder to digest. After cholecystectomy, it is essential that the patient has an adequate intake of water, around 2500 to 3000 mL per day. The patient should not have the usual foods that he or she used to consume; modifications are needed to facilitate easy digestion of food in the absence of the gallbladder.

Which dietary advice will the nurse give a patient after a cholecystectomy? Select all that apply. a. Eat a high-fiber diet. b. Limit intake of water. c. Use the same diet as before. d. Have small but frequent meals. e. Avoid or keep fats to a minimum.

c. Include fat-soluble vitamins. Patients with chronic gallbladder diseases have a deficiency of fat-soluble vitamins. Therefore the nurse should include fat-soluble vitamins in the patient's diet plan. Dairy products are rich in saturated fats, which are contraindicated for patients with gallbladder disease because dairy stimulates the gallbladder, causing pain. A low-protein diet is given to patients with kidney disease because improper functioning of the kidneys reduces the ability to excrete the nitrogenous waste. As a result, these substances accumulate in the brain, leading to neurologic complications. Refined cereals have less fiber content. However, patients with gallbladder disease require a diet high in fiber because fiber is known to reduce the risk of developing gallstones, thereby preventing complications.

Which dietary recommendation would the nurse give to a patient with chronic gallbladder disease? a. Include dairy products. b. Maintain a low-protein diet. c. Include fat-soluble vitamins. d. Increase the intake of refined cereals.

a. Fat Cholecystitis is inflammation of the gallbladder. Fats contribute to gallstone formation, worsening the inflammation; therefore patients with cholecystitis should consume a low-fat diet. A diet low in protein is given to patients with kidney or liver disease. Patients with cholecystitis should be given a diet rich in calcium and carbohydrates.

Which dietary substance would the nurse recommend limiting for a patient with acute cholecystitis? a. Fat b. Protein c. Calcium d. Carbohydrates

c. Adrenal insufficiency The mainstay treatment of adrenal insufficiency is lifelong hormone therapy with glucocorticoids and mineralocorticoids. Thyrotoxicosis, nephritic syndrome, and rheumatoid arthritis are treated with corticosteroid drug therapy.

Which disease is treated with corticosteroidal hormonal therapy? a. Thyrotoxicosis b. Nephrotic syndrome c. Adrenal insufficiency d. Rheumatoid arthritis

d. Two thirds of a dose in the morning and one third in the afternoon Glucocorticoids are administered in divided doses, two thirds in the morning and one third in the afternoon, to reflect normal circadian rhythms in endogenous hormone secretion. Note that mineralocorticoids are administered once daily in the morning.

Which dosage schedule would be recommended for the administration of glucocorticoids? a. One dose every night b. One dose every morning c. Two thirds of a dose in the morning and one third at night d. Two thirds of a dose in the morning and one third in the afternoon

a. Quinine Quinine, which is used in many herbal preparations and tonic water, accelerates platelet destruction caused by drug-dependent antibodies. Antibodies attack the platelets when the offending agent binds to the platelet surface. Aspirin alters platelet aggregation. Antiinfectives such as ganciclovir and chemotherapeutic drugs such as vincristine decrease platelet count by myelosuppression. Acetaminophen does not affect blood coagulation in and of itself.

Which drug is a likely cause of thrombocytopenia? a. Quinine b. Vincristine c. Ganciclovir d. Acetaminophen

c. Ganciclovir Ganciclovir is an antiinfective drug that causes thrombocytopenia; it is directly myelosuppressive. Abciximab is a platelet glycoprotein inhibitor that causes thrombocytopenia. Cimetidine is a histamine H -receptor antagonist that causes thrombocytopenia. Haloperidol is an antipsychotic drug that causes thrombocytopenia.

Which drug is directly myelosuppressive and may induce thrombocytopenia? a. Abciximab b. Cimetidine c. Ganciclovir d. Haloperidol

a. Rituximab Rituximab has the ability to decrease the level of inhibitory ADAMTS13 IgG antibodies, thus reducing the immune recognition of platelets. Prednisone has the ability to suppress the phagocytic response of splenic macrophages. Argatroban is a direct thrombin inhibitor. IV immunoglobulin acts by competing with the antiplatelet antibodies for macrophage receptors in the spleen.

Which drug used for patients with thrombotic thrombocytopenic purpura (TPP) decreases the level of inhibitory ADAMTS13 immunoglobulin G (IgG) antibodies? a. Rituximab b. Prednisone c. Argatroban d. IV immunoglobulin

a. Omeprazole Omeprazole is a proton pump inhibitor that acts by decreasing production of hydrochloric acid in the stomach. Dicyclomine is an antispasmodic used to relieve muscle spasms. Nitroglycerin is an example of a vasodilator drug that dilates the blood vessels and is used to relax the smooth muscles. Acetazolamide is a carbonic anhydrase inhibitor used to decrease the volume and concentration of bicarbonate in pancreatic secretions.

Which drug would the nurse anticipate administering to a patient to reduce gastric acid secretion? a. Omeprazole b. Dicyclomine c. Nitroglycerin d. Acetazolamide

b. Infections A patient may become susceptible to infections if the endogenous corticosteroid levels are high during surgery. Fatigue and delusions may not occur due to elevated corticosteroids. Hypertension, not hypotension, is observed due to increased levels of corticosteroids.

Which effect may be observed if large amounts of endogenous corticosteroids are released into systemic circulation during surgery on a patient with Cushing syndrome? a. Fatigue b. Infections c. Delusions d. Hypotension

a. Reduction in neuropathic pain Nortriptyline is an antidepressant that is effective in reducing neuropathic pain in patients with chronic pancreatitis. Chronic pancreatitis is also associated with hyperglycemia, and insulin is injected to correct the increased blood glucose levels. Gastric acid secretions, nausea, and vomiting are reduced by antacids such as omeprazole. Patients with chronic pancreatitis have a deficiency of pancreatic enzymes. Products such as pancrelipase and Creon are prescribed to improve the digestion of fatty foods.

Which effect would the nurse expect after administering nortriptyline to a patient with chronic pancreatitis? a. Reduction in neuropathic pain b. Normalization of blood glucose c. Decreased nausea and vomiting d. Improved digestion of fatty foods

b. Activated trypsin In acute pancreatitis, trypsin that is present in the pancreas autodigests the pancreas, resulting in bleeding. Enterokinase converts inactivated trypsinogen produced by the pancreas into activated trypsin. Alkaline phosphatase and alanine aminotransferase are liver enzymes and do not play a role in pancreatitis.

Which enzyme is responsible for autodigestion of the pancreas and leads to bleeding in a patient with acute pancreatitis? a. Enterokinase b. Activated trypsin c. Alkaline phosphatase d. Alanine aminotransferase

a. Emergency An emergency is defined as an event that requires a rapid and skilled medical response that existing resources can manage easily. A natural disaster is one type of mass casualty incident and usually requires more resources than the community has available and requires outside assistance. Terrorism involves overt actions, such as the use of nuclear, biologic, or chemical weapons, to cause harm and will involve federal agencies in the response. Mass casualty incidents can be natural or human-made but will require assistance from outside resources and agencies.

Which event is defined as requiring a rapid and skilled medical response that existing resources can manage easily? a. Emergency b. Natural disaster c. Acts of terrorism d. Mass casualty incident

d. The patient will demonstrate maintenance of weight. Graves' disease, which results from hyperthyroidism, causes an increase in metabolism. Untreated, it may cause unexplained weight loss. It is important for the nurse to plan care to support an expected outcome to maintain or gain weight. Risk for infection and fluid overload are not direct issues related to hyperthyroidism. Because of the increased secretion of thyroid hormone, these patients will be hyperalert and anxious and may have difficulty sleeping. Therefore the goal of remaining awake, alert, and oriented is not a priority.

Which expected outcome would be included in the plan of care for a patient with Graves' disease? a. The patient will be free of infection. b. The patient will remain awake, alert, and oriented. c. The patient will be compliant with fluid restrictions. d. The patient will demonstrate maintenance of weight.

d. To find any central nervous system involvement A lumbar puncture is performed in a patient with lymphoma to rule out central nervous system involvement. Bone marrow biopsy would determine whether there is bone marrow involvement in the lymphoma. Cell differentiation would be determined by analysis of the lymph node biopsy. The lymph node biopsy would be analyzed to establish which type of lymphocytes are affected.

Which explanation will the nurse give a patient with non-Hodgkin's lymphoma about the purpose of a planned lumbar puncture? a. To rule out any bone marrow involvement b. To determine the level of cell differentiation c. To establish which lymph cell type is involved d. To find any central nervous system involvement

b. ALL is initially treated with both IV and intrathecal chemotherapy drugs. ALL is characterized by a proliferation of immature white blood cells and frequently infiltrates the central nervous system (CNS); it is treated initially with IV combination chemotherapy and intrathecal chemotherapy to prevent CNS involvement. ALL is rapidly progressive, and patients deteriorate quickly without treatment. Affected lymphocytes in ALL are immature and poorly differentiated; radiation is not an initial treatment. ALL is not infectious in nature, and antibiotics are not used to treat ALL.

Which explanation would the nurse give when a patient with acute lymphocytic leukemia (ALL) asks for clarification about the disease and expected treatment? a. ALL is frequently slowly progressive and may not need treatment immediately. b. ALL is initially treated with both IV and intrathecal chemotherapy drugs. c. ALL is characterized by well differentiated lymphocytes and may be initially treated with radiation. d. ALL is caused by an infectious agent and usually is initially treated with multiple antibiotics.

b. Deposition of bile salts in tissues Pruritus is manifested by itching and is caused by deposition of bile salts in skin tissues. Solubility of bilirubin in the urine results in amber-colored urine that foams on shaking; it does not result in pruritus. Vitamin K is an important element in the clotting pathway. Its decreased absorption may cause clotting problems, resulting in bleeding. When bile does not flow into the duodenum, it accumulates in the systemic circulation and results in obstructive jaundice.

Which factor explains why patients with cholelithiasis experience pruritus? a. Solubility of bilirubin in urine b. Deposition of bile salts in tissues c. Decreased absorption of vitamin K d. Bile not flowing into the duodenum

d. Adrenal hemorrhage Iatrogenic Addison's disease may be caused by an adrenal hemorrhage, which is related to anticoagulant therapy, chemotherapy, or ketoconazole therapy for acquired immunodeficiency syndrome (AIDS). Infarction, tuberculosis, and fungal infections may lead to Addison's disease.

Which factor may be the cause of iatrogenic Addison's disease? a. Infarction b. Tuberculosis c. Fungal infections d. Adrenal hemorrhage

b. Portal hypertension c. Hyperaldosteronism e. Decreased serum colloidal oncotic pressure Portal hypertension causes an increase in resistance to blood flow in the liver leading to ascites. Hyperaldosteronism, or increased secretion of aldosterone, causes ascites. When there is decreased serum colloidal oncotic pressure, there is impairment of synthesis of albumin and loss of albumin in the peritoneal cavity, leading to ascites. Diabetes is a metabolic syndrome and does not cause ascites. Increased flow of hepatic lymph, not decreased flow, leads to ascites.

Which factors can lead to a patient developing ascites? Select all that apply. a. Diabetes mellitus b. Portal hypertension c. Hyperaldosteronism d. Decreased flow of hepatic lymph e. Decreased serum colloidal oncotic pressure

b. Vitamin absorption Bile salts help in the absorption of vitamins and the digestion of food. Proteases are the enzymes that metabolize proteins. Glucose is metabolized by the liver, and ammonia is eliminated by the kidneys.

Which function do bile salts facilitate in the body? a. Protein metabolism b. Vitamin absorption c. Glucose metabolism d. Ammonia elimination

d. Decreased serum calcium During thyroid surgery, the parathyroid glands are often unavoidably removed. The result is an inability to regulate serum calcium, stemming from a lack of parathyroid hormone. In hypoparathyroidism, there is a decrease in parathyroid hormone, which results in decreased serum calcium and increased phosphorus levels. An increase in thyroxine is not seen after thyroidectomy; the thyroxine level may actually drop below normal. Decreased phosphorus and increased serum calcium levels may occur initially after a thyroidectomy because of manipulation of the thyroid gland during surgery. This causes a surge of parathormone, but the level does decrease if the parathyroid glands are removed.

Which finding is of most concern when the nurse reviews laboratory values for a patient who underwent thyroidectomy 48 hours ago? a. Increased thyroxine b. Decreased phosphorus c. Increased serum calcium d. Decreased serum calcium

c. A patient has a platelet count of 100,000/µL. Long-term heparin therapy can cause HIT that results in a decrease in the platelet count. A platelet count of 100,000/µL indicates HIT. Immune thrombocytopenic purpura (ITP) will be suspected if the patient has a viral infection. Thrombotic thrombocytopenic purpura (TTP) will be suspected if the patient has hemolytic anemia and an autoimmune disorder like systemic lupus erythematosus.

Which finding supports heparin-induced thrombocytopenia (HIT)? a. A patient has a viral infection. b. A patient has hemolytic anemia. c. A patient has a platelet count of 100,000/µL. d. A patient has systemic lupus erythematosus.

b. Smooth, beefy-red tongue Pernicious anemia is characterized by the presence of abdominal pain and a smooth, beefy-red tongue. Platelet function is reduced in the patient with leukemia; therefore bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron-deficiency anemia.

Which finding supports the nurse's conclusion that a patient has pernicious anemia? a. Bleeding of the gums b. Smooth, beefy-red tongue c. Spoon-shaped concave nails d. Fissures in corners of the mouth

c. Patient has an enlarged and nontender cervical lymph node. Since HIV infection increases the risk for developing Hodgkin's or non-Hodgkin's lymphoma, the finding of an enlarged and nontender lymph node will be reported to the health care provider, and the nurse will anticipate diagnostic testing such as lymph node biopsy. The patient's BMI is within the normal range of 18.5 to 25. While current injectable drug use would be of concern, a history of injectable drug use is a common risk factor for HIV. The patient's newly initiated treatment for HIV will need ongoing monitoring and follow-up but is not as concerning as the possible complication of Hodgkin's lymphoma.

Which finding will be of most concern when the nurse assesses a patient who is infected with human immunodeficiency virus (HIV)? a. Patient's body mass index (BMI) is 21. b. Patient reports a history of injectable drug use. c. Patient has an enlarged and nontender cervical lymph node. d. Patient has just started multiple drug antiretroviral therapy.

b. Enlarged lymph nodes Enlarged lymph nodes are the most common initial finding in Hodgkin's lymphoma. Skeletal pain might occur with bone involvement, but this would occur in later stages of the disease. T-cell blasts in the lymph nodes occur with some types of non-Hodgkin's lymphoma but are not found in Hodgkin's lymphoma, which is a lymphoma of B lymphocytes. Lymphoblasts in the cerebrospinal fluid are a diagnostic finding of acute lymphocytic lymphoma and would not be found in stage I Hodgkin's lymphoma.

Which finding will the nurse expect in a patient who is hospitalized with stage I Hodgkin's lymphoma? a. Skeletal pain b. Enlarged lymph nodes c. T-cell blasts in the lymph node d. Lymphoblasts in the cerebrospinal fluid

c. Abdominal rigidity Physical findings in patients with cholecystitis are abdominal rigidity and tenderness in the right upper quadrant. A spider angioma is a manifestation of liver cirrhosis wherein the patient has a small, dilated blood vessel with a red center and branching of the blood vessel. Flapping tremors are seen in patients with hepatic encephalopathy, which is characterized by rapid flexion and extension movements when asked to stretch the hand. Grey Turner's sign is a manifestation of acute pancreatitis characterized by bluish discoloration of the flanks.

Which finding would the nurse expect in a patient who has cholecystitis? a. Spider angioma b. Flapping tremors c. Abdominal rigidity d. Grey Turner's sign

c. Hypercellular bone marrow with myeloblasts Hypercellular bone marrow with myeloblasts indicates AML. Hypercellular bone marrow with lymphoblasts and presence of lymphoblasts in cerebrospinal fluid are observed in acute lymphocytic leukemia (ALL). An increase in peripheral lymphocytes and lymphocytes in the bone marrow are noted in chronic lymphocytic leukemia (CLL).

Which finding would the nurse expect when assessing a patient with acute myelogenous leukemia (AML)? a. Hypercellular bone marrow with lymphoblasts b. Presence of lymphoblasts in cerebrospinal fluid c. Hypercellular bone marrow with myeloblasts d. Increased peripheral lymphocytes and lymphocytes in the bone marrow

d. Skim milk Skim milk is rich in calcium and low in fat. Patients with cholelithiasis should consume a diet rich in calcium and fiber and low in fat. Butter, yogurt, and cheese are rich in fats. Fat-rich foods should not be consumed by patients with biliary tract disease such as cholelithiasis or cholecystitis.

Which food in the patient's diet would likely facilitate improvement in the condition of cholelithiasis? a. Butter b. Yogurt c. Cheese d. Skim milk

c. Cauliflower Goitrogens are foods or drugs that contain thyroid-inhibiting substances, which increase the likelihood of goiter development. Cauliflower is a classic example of a vegetable which is a goitrogen; carrots, tomatoes, and bell peppers are nongoitrogenic vegetables.

Which food item would be included on a list of foods that fall under the category of goitrogens? a. Carrot b. Tomato c. Cauliflower d. Bell peppers

a. Legumes b. Dried fruits e. Dark-green, leafy vegetables Legumes, dried fruits, and dark-green, leafy vegetables contain iron, which supports hemoglobin synthesis. Milk products contain riboflavin and amino acids but do not support hemoglobin synthesis. Strawberries provide vitamin C, which converts folic to its active forms and aids iron absorption but not hemoglobin synthesis.

Which foods would the nurse encourage the patient to eat in order to provide nutritional support for hemoglobin synthesis? Select all that apply. a. Legumes b. Dried fruits c. Strawberries d. Milk products e. Dark-green, leafy vegetables

a. Farm workers Pesticide exposure increases risk for leukemia and non-Hodgkin's lymphomas, and farm workers are more likely to develop these illnesses than the general population. Office managers are not at higher risk for cell changes that may lead to cancer. Police officers are not at higher risk for development of leukemia or lymphoma. College professors are not at higher risk for leukemia or lymphoma.

Which group of people is at high risk for developing leukemia and non-Hodgkin's lymphoma? a. Farm workers b. Office managers c. Police officers d. College professors

a. Avoid alcohol. d. Take lactulose as directed. e. Expect urinary frequency with spironolactone. Management of cirrhosis focuses on slowing the progression of disease while preventing or treating complications. Abdominal distension and a visible fluid wave are signs of ascites, a complication of cirrhosis and an indication of disease progression. Cessation of alcohol consumption will prevent further damage to the liver. Sodium restriction is a hallmark of ascites management and can help prevent the reaccumulation of fluid. Lactulose Lactulose is used to treat hepatic encephalopathy and manage ammonia levels. Frequent loose stools result, and patients very often need to be encouraged to take the medication as directed. Spironolactone is an aldosterone antagonist and potassium-sparing diuretic that is frequently used to help manage ascites. The nurse will discuss the therapeutic effect with the patient, which is increased urination. Referral to nephrology is not likely to be necessary at this point as there is nothing to suggest impaired kidney function.

Which guidance would the nurse provide to a patient diagnosed with cirrhosis whose abdomen is distended and has a visible fluid wave? Select all that apply. a. Avoid alcohol. b. See a nephrologist. c. Restrict sodium in the diet. d. Take lactulose as directed. e. Expect urinary frequency with spironolactone.

b. Burkitt's lymphoma d. Hodgkin's lymphoma The major characteristic of lymphoma is painless lymph node enlargement. Weight loss, fever, and drenching night sweats are characterized as B manifestations of Hodgkin and non-Hodgkin's lymphomas and indicate a poorer prognosis in both types of lymphoma. Clinical manifestations of thalassemia do not include enlarged lymph nodes, weight loss, fever, or night sweats. Megaloblastic anemias are not characterized by lymphadenopathy, weight loss, fever, or night sweats. Myelodysplastic syndrome does not include symptoms of fever, weight loss, night sweats or lymphadenopathy. Immune thrombocytopenic purpura symptoms do not include enlarged lymph nodes, fever, night sweats, or weight loss.

Which hematologic diseases may have symptoms of weight loss, fever, drenching night sweats, and painless lymph node enlargement? Select all that apply. a. Thalassemia b. Burkitt's lymphoma c. Megaloblastic anemia d. Hodgkin's lymphoma e. Myelodysplastic syndrome f. Immune thrombocytopenic purpura

b. Hepatitis B The hepatitis B virus is transmitted perinatally from mother to fetus. Studies show that most mother-to-child hepatitis B virus (HBV) transmission occurs during or shortly before delivery. The hepatitis A virus is transmitted through the fecal-oral route by consuming foods or drinks contaminated with the hepatitis A virus. The hepatitis C virus is transmitted by sharing contaminated needles. The hepatitis E virus is also transmitted by the fecal-oral route.

Which hepatitis virus is transmitted from mother to fetus? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis E

d. Adrenocorticotropic hormone (ACTH) CTH may lead to acute adrenal insufficiency and shock. This may result in a life-threatening situation because of sodium and water depletion. Prolactin plays a role in lactation. Oxytocin is a hormone that is particularly functional during and after childbirth. FSH is associated with reproduction and is responsible for the development of eggs in females and sperm in males. The absence of these other hormones is not life threatening.

Which hormone deficiency may lead to a life-threatening condition? a. Prolactin b. Oxytocin c. Follicle-stimulating hormone (FSH) d. Adrenocorticotropic hormone (ACTH)

d. Hydrocortisone Hydrocortisone is an exogenous hormone that has both mineralocorticoid and glucocorticoid properties and is used to treat adrenal insufficiency. Cortisol is the primary glucocorticoid secreted by the adrenal cortex. Prednisone is an exogenous corticosteroid that is used to treat Cushing syndrome. Aldosterone is the primary mineralocorticoid secreted by the adrenal cortex.

Which hormone has both mineralocorticoid and glucocorticoid properties? a. Cortisol b. Prednisone c. Aldosterone d. Hydrocortisone

a. A cirrhotic liver is characterized by diffuse nodularity on the surface due to a combination of regeneration of liver cells and scarring, as seen in image A. Images B and D show metastatic liver carcinomas. Image C shows acute pancreatitis.

Which image best shows a cirrhotic liver? a. b. c. d.

b. Consume a low-fat diet. c. Avoid consuming alcohol. e. Consume a high-carbohydrate diet. Consuming a low-fat, high-carbohydrate diet is essential in pancreatitis. Fats should be avoided because they stimulate the secretion of cholecystokinin, which then stimulates the pancreas. Alcohol is an irritant and must be avoided. Fluid intake should be increased to prevent dehydration. Carbohydrates are less stimulating to the pancreas and are encouraged.

Which information about diet would the nurse provide for a patient who is diagnosed with acute pancreatitis? Select all that apply. a. Limit fluid intake. b. Consume a low-fat diet. c. Avoid consuming alcohol. d. Consume a low-carbohydrate diet. e. Consume a high-carbohydrate diet.

a. It interferes with the regulation of cell proliferation. The protein that is encoded by the newly created BCR-ABL gene on the Philadelphia chromosome interferes with normal cell cycle events such as the regulation of cell proliferation. Absence of the Philadelphia chromosome is an expected marker for remission in leukemia; if the Philadelphia chromosome persists, the patient is not in remission. The Philadelphia chromosome occurs most frequently in chronic myelogenous leukemia but is sometimes found in acute lymphocytic leukemia and occasionally in acute myelogenous leukemia. It is not found with chronic leukocytic leukemia. The Philadelphia chromosome is not a congenital defect but occurs later in life because of exposure to factors such as oncogenes, environment, and viruses.

Which information about the Philadelphia chromosome in leukemia is accurate? a. It interferes with the regulation of cell proliferation. b. It persists even after leukemia is in complete remission. c. It occurs most frequently in chronic leukocytic leukemia. d. It presents as a congenital defect in children who develop leukemia.

b. Treatment includes chemotherapy. d. Long-term survival exceeds 80% for all stages. e. Fever, drenching night sweats, and weight loss are common. Chemotherapy is the initial treatment for Hodgkin's lymphoma, and long-term survival exceeds 80%. B symptoms, such as fever, night sweats, and weight loss, indicate a worse prognosis and are common. Hodgkin's lymphoma usually starts in a single node but can spread diffusely and infiltrate other organs. Anemia may occur because of decreased red blood cell production and increased red blood cell destruction, but polycythemia is not a complication of Hodgkin's lymphoma.

Which information is accurate about Hodgkin's lymphoma? Select all that apply. a. Extranodal spread does not occur. b. Treatment includes chemotherapy. c. Polycythemia is frequently a complication. d. Long-term survival exceeds 80% for all stages. e. Fever, drenching night sweats, and weight loss are common.

b. Exposure to chemical toxins The subjective data category includes information taken from the patient, such as the patient reporting exposure to chemical toxins. The objective data category includes information regarding diagnostic findings, such as Philadelphia chromosome. The observed information related to the integumentary findings, like reddish-brown cutaneous filtrates, is documented in the objective data section. Bleeding gums would be noted by the nurse and documented in the objective data section.

Which information obtained by the nurse during the admission of a patient with leukemia would be documented under the subjective data section? a. Gingival bleeding b. Exposure to chemical toxins c. Presence of Philadelphia chromosome d. Presence of reddish-brown cutaneous infiltrates

d. Graft-versus-host disease is a complication of allogenic HSCT. Graft-versus-host disease is a common complication following allogenic HSCT as the donor cells attack the patient's own cells, causing symptoms such as rashes, diarrhea, and jaundice. Because HSCT involves eradication of the patient's own hematopoietic stem cells and causes severe immune suppression, risk for life-threatening infection is high. Relapse may occur even with HSCT. Autologous HSCT involves using the patient's own stem cells, while allogenic HSCT is done using donor cells.

Which information will the nurse include when teaching a patient about allogenic hematopoietic stem cell transplantation (HSCT) therapy as treatment for leukemia? a. Infection risk is low with allogenic HSCT. b. Relapse is rare after allogenic HSCT treatment. c. Allogenic HSCT involves use of the patient's own stem cells. d. Graft-versus-host disease is a complication of allogenic HSCT.

c. "Prevention and early detection of infection are important during leukemia treatment." Since neutropenia is a common adverse effect of leukemia chemotherapy, education about how to prevent infection and clinical manifestations of infection is important to include in patient education. While leukemia treatment does have severe side effects, the side effects resolve when treatment is stopped. There is no indication that the patient needs assistance when getting out of bed for safety reasons, and insisting that assistance is needed will encourage over-dependence and may cause depression. While feeling isolated is a common consequence of leukemia and leukemia treatment, the nurse will plan ways to help the patient to avoid feeling isolated rather than stating that feelings of isolation are inevitable.

Which information will the nurse include when teaching a patient who is receiving chemotherapy for leukemia? a. "The treatment has severe side effects, some of which will be permanent." b. "You need to use your call light to ask for help every time you get out of bed." c. "Prevention and early detection of infection are important during leukemia treatment." d. "Feeling isolated is a common and unavoidable consequence of leukemia treatment."

b. Chemotherapy is given every three to four weeks for a prolonged period. In maintenance therapy, treatment is provided every three to four weeks for a prolonged period with lower doses of the drugs. Intensification therapy is the highdose treatment given immediately after induction therapy. Intensification and consolidation are the terms used to describe post-induction or post-remission therapy. Maintenance chemotherapy is given at lower doses and longer intervals and is better tolerated by patients; severe bone marrow depression and critical illness are not expected.

Which information will the nurse include when teaching a patient with leukemia about maintenance chemotherapy? a. It is the high-dose treatment given immediately after induction therapy. b. Chemotherapy is given every three to four weeks for a prolonged period. c. Intensification and consolidation are other terms used to describe this therapy. d. Severe bone marrow depression and critical illness are common complications.

d. Lifelong hormone replacement will be needed. This patient will need lifelong thyroid hormone replacement with levothyroxine because the entire thyroid gland will be missing after surgery. Exercise will not be restricted for six months. Lengthy exercise restriction or physical therapy generally is not indicated following a thyroidectomy. A sodium-restricted diet would not ordinarily be necessary.

Which information would the nurse include in the teaching plan for a patient scheduled for a total thyroidectomy about recovery after the procedure? a. Exercise will be restricted for up to six months. b. A low- or no-sodium diet will be prescribed. c. Physical therapy will need to be continued. d. Lifelong hormone replacement will be needed.

d. DIC is a secondary disease of clotting and hemorrhage. DIC disorder is a disorder in which underlying disease stimulates the coagulation system leading to diffuse clotting and hemorrhage. It is a disorder in which the underlying disease depletes clotting factors in blood. DIC is a disorder in which tissue factor released at the site of injury leads to overstimulation of the coagulation process in the vasculature. The coagulation pathway is not genetically altered in DIC.

Which information would the nurse include when preparing to discuss the etiology and pathophysiology of disseminated intravascular coagulation (DIC)? a. The coagulation pathway is overstimulated. b. DIC is due to the depletion of hemolytic factors. c. The coagulation pathway is genetically altered. d. DIC is a secondary disease of clotting and hemorrhage.

b. Consume a high-calorie diet. c. Eat snacks high in protein. d. Avoid caffeinated beverages. A diet high in calories and protein is encouraged. Caffeinated beverages should be avoided. High-fiber foods should be avoided, not encouraged, because they can further stimulate the already hyperactive gastrointestinal tract. The patient should increase intake of carbohydrate-rich foods to compensate for the increased metabolism. This provides energy and decreases the use of body-stored protein.

Which instructions would the nurse include in a dietary teaching plan provided to a patient who is diagnosed with hyperthyroidism? Select all that apply. a. Eat a high-fiber diet. b. Consume a high-calorie diet. c. Eat snacks high in protein. d. Avoid caffeinated beverages. e. Decrease the intake of carbohydrates.

a. Insertion of a T-tube following surgery Open cholecystectomy involves removal of the gallbladder through an abdominal incision. The T-tube facilitates drainage from the common bile duct into an external collection device. The T-tube is then discontinued, and the insertion point heals spontaneously. Radiofrequency ablation involves insertion of a needle into the core of the tumor and is performed on patients with liver cancer. The Whipple procedure is used in pancreatic cancer and involves resection of the proximal pancreas and duodenum. Administration of an embolic agent through the catheter into the artery near the tumor is done in chemoembolization, which is a treatment option for patients with liver cancer.

Which information would the nurse include when teaching a student nurse about an open cholecystectomy? a. Insertion of a T-tube following surgery b. Insertion of a needle into the core of the tumor c. Resection of the proximal pancreas and duodenum d. Administration of an embolic agent through a catheter

b. Oxygenation helps to stabilize the patient with DIC. As a part of collaborative care, it is necessary to diagnose DIC disorder quickly through oxygenation or volume replacement to control the thrombosis and bleeding. If chronic DIC disorder is diagnosed in a patient who is not bleeding, no therapy for DIC disorder is required. Treatment of the underlying disease is sufficient to reverse DIC disorder. If the patient with DIC disorder is bleeding, the therapy requires providing support with necessary blood products that aim to treat the primary disorder.

Which information would the nurse include when teaching nursing students about treatment for disseminated intravascular coagulation (DIC)? a. Therapy is essential for chronic DIC. b. Oxygenation helps to stabilize the patient with DIC. c. Treatment for the underlying disease cannot reverse DIC. d. Blood products are not effective in treating the patient with DIC who has a bleeding disorder.

c. A diet lower in fat may be better tolerated for several weeks. Although the usual diet can be resumed, a low-fat diet usually is better tolerated for several weeks following surgery. Normal activities can be resumed gradually as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.

Which information would the nurse provide to the patient after a laparoscopic cholecystectomy? a. Do not return to work or normal activities for three weeks. b. Bile-colored drainage probably will drain from the incision. c. A diet lower in fat may be better tolerated for several weeks. d. Keep the bandages on and the puncture site dry until it heals.

d. NHL is a broad group of malignant neoplasms with a variety of presentations NHLs are a heterogeneous group of malignant neoplasms of primarily B-cell, T-cell, or natural killer (NK) cell origin. NHL is frequently disseminated and affects nonlymphatic organs, such as the brain or liver. While B symptoms such as fever, night sweats, and weight loss can occur, they are uncommon in NHL. NHL can affect persons of any age while Hodgkin's lymphoma has a bimodal peak incidence at ages 15 to 30 and over 55 years old.

Which information would the nursing instructor include when teaching about non-Hodgkin's lymphoma (NHL)? a. NHL is confined to the regional lymph nodes and lymphatic tissues. b. Night sweats, fever, and weight loss are common associated symptoms. c. Incidence is most frequent at ages 15 to 30 years or over 55 years of age. d. NHL is a broad group of malignant neoplasms with a variety of presentations

a. Use soap sparingly. The nurse should teach the patient and caregiver measures to prevent skin breakdown. The patient should be taught to use soap sparingly and apply lotion frequently to the skin. The patient should be instructed to avoid the use of enemas because they produce vagal stimulation, which can be hazardous if cardiac disease is present. The patient should be asked to increase the intake of fiber in the diet to minimize constipation.

Which instruction would the nurse give the patient and caregiver about managing hypothyroidism? a. Use soap sparingly. b. Avoid applying lotions to the skin. c. Use an enema if constipated. d. Reduce intake of dietary fiber.

c. Take the iron with orange juice one hour before meals. With microcytic, hypochromic anemia, there may be an iron, B , or copper deficiency; thalassemia; or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals, as it is absorbed best in an acid environment. Enteric-coated capsules would not be used because iron is best absorbed in an acidic environment. Megaloblastic anemias occur with cobalamin (vitamin B ) and folic acid deficiencies. Vitamin B may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green, leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

Which instruction would the nurse include in the teaching plan for a patient newly diagnosed with microcytic hypochromic anemia? a. Take enteric-coated iron with each meal. b. Take cobalamin with green, leafy vegetables. c. Take the iron with orange juice one hour before meals. d. Decrease the intake of the antiseizure medications to improve.

b. Dilute the liquid iron and ingest it through a straw. Undiluted liquid iron may stain the patient's teeth; therefore liquid iron should be diluted and ingested through a straw. Iron is best absorbed as ferrous sulfate (Fe ) in an acidic environment. Therefore iron supplements should be taken about an hour before meals when the duodenal mucosa is acidic. Orange juice contains vitamin C (ascorbic acid), which enhances iron absorption. Therefore it is advisable to take vitamin C supplements along with iron. Constipation may commonly occur in patients who are prescribed iron therapy. Therefore it is advisable to take laxatives and stool softeners when receiving iron therapy.

Which instruction would the nurse include when teaching a patient about the administration of an iron supplement? a. Take the iron supplement with food. b. Dilute the liquid iron and ingest it through a straw. c. Refrain from drinking orange juice when taking iron. d. Refrain from the use of laxatives when on iron therapy.

c. "Take it one hour before breakfast, with orange juice." Iron is absorbed best as ferrous sulfate in an acidic environment. For this reason, and to avoid binding the iron with food, iron should be taken about an hour before meals, when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice, which contains ascorbic acid, enhances iron absorption. Gastric side effects, however, may necessitate ingesting iron with meals.

Which instruction would the nurse include when teaching a patient about the administration of an oral iron substitute? a. "Take it with meals." b. "Take it one hour after eating." c. "Take it one hour before breakfast, with orange juice." d. "Take it on an empty stomach with a full glass of water."

b. Avoid using enemas. c. Avoid using sedatives. d. Take the prescribed medication before breakfast. A patient diagnosed with both hypothyroidism and CAD should be taught to avoid enemas due to the risk of vagal stimulation, to avoid the use of sedatives for insomnia, and to take medication in the morning before breakfast. A high-fiber diet is recommended to avoid constipation. Different brands of hormones may have different bioavailability and should be avoided.

Which instructions would the nurse include in a teaching plan for a patient who has a history of coronary artery disease (CAD) and is newly diagnosed with hypothyroidism? Select all that apply. a. Eat a low-fiber diet. b. Avoid using enemas. c. Avoid using sedatives. d. Take the prescribed medication before breakfast. e. Alternate between the trade and generic brands of the medication.

c. "Avoid blowing your nose forcefully. Instead, gently pat it with a tissue." e. "Notify your health care provider if you have black, tarry bowel movements." f. "Notify your health care provider if you have difficulty speaking or sudden weakness in the arm or leg." Self-care measures to reduce the risk of bleeding include avoiding blowing the nose forcefully. It is also important to notify the health care provider of any black, tarry stools, as this is a sign of upper gastrointestinal bleeding. The patient should notify the health care provider of difficulty speaking or sudden weakness in the extremities. This can indicate that the patient may be experiencing an intracerebral hemorrhage. Patients with thrombocytopenia should not use a razor blade to shave; an electric razor is preferred due to bleeding potential. Patients with thrombocytopenia should not take aspirin or ibuprofen, as these drugs increase the risk of bleeding. Constipation should be avoided by increasing fluid intake and using stool softeners. Enemas and rectal suppositories should be avoided because their use may result in bleeding.

Which instructions would the nurse include when discharging a patient with thrombocytopenia? Select all that apply. a. "Use a high-quality disposable razor for shaving." b. "Take aspirin or ibuprofen to treat minor discomforts." c. "Avoid blowing your nose forcefully. Instead, gently pat it with a tissue." d. "Use a small-volume enema or rectal suppository to treat constipation." e. "Notify your health care provider if you have black, tarry bowel movements." f. "Notify your health care provider if you have difficulty speaking or sudden weakness in the arm or leg."

b. Walk with sturdy shoes. d. Avoid blowing the nose forcefully. f. Shave only with an electric shaver. The nurse should instruct the patient to shave only with an electric shaver and avoid using blades. The patient should avoid blowing the nose forcefully; instead, gently pat it with a tissue. The patient should always walk with sturdy shoes for safety. The patient should drink plenty of fluids to prevent constipation. The patient should avoid using a suppository without the permission of the health care provider; the patient may be prescribed stool softeners. Alcohol-based mouthwashes should be avoided because they can dry the gums and increase bleeding.

Which instructions would the nurse include when educating a patient with chemotherapy induced thrombocytopenia? Select all that apply. a. Reduce water intake. b. Walk with sturdy shoes. c. Use a suppository if required. d. Avoid blowing the nose forcefully. e. Use an alcohol-based mouthwash. f. Shave only with an electric shaver.

a. Avoid contact sports. b. Perform oral hygiene daily. d. Wear gloves while doing household chores. A patient diagnosed with bleeding disorders such as hemophilia should be advised to play only noncontact sports such as golf to avoid injuries and should perform oral hygiene daily without causing trauma. Gloves should be used while doing household chores to prevent abrasions and cuts from knives and other tools. Alcohol-based mouthwashes should be avoided because they dry the gums and increase bleeding. If there is a nosebleed, then the patient should be advised to gently pat the nose with a tissue because forceful blowing may further increase bleeding.

Which instructions would the nurse include when teaching home care measures to a patient diagnosed with hemophilia? Select all that apply. a. Avoid contact sports. b. Perform oral hygiene daily. c. Use alcohol-based mouthwashes. d. Wear gloves while doing household chores. e. Blow your nose with force if there is a nosebleed.

a. Avoid preparing food for others. c. Launder personal towels, bed linens, and clothes separately at home. d. Avoid being close to pregnant women or children for seven days after therapy. The nurse should instruct the patient receiving RAI therapy to avoid preparing food for others; to launder personal towels, bed linens, and clothes separately at home; and to avoid being close to pregnant women or children for seven days after therapy. These precautions are to limit radiation exposure to others. The patient is asked to use a salt and soda gargle three or four times per day to provide relief from dryness and irritation of the mouth and throat as a result of the therapy. RAI has a delayed response, and the maximum effect may not be seen for up to three months; therefore the patient is usually treated with antithyroid drugs and propranolol before and for three months after the initiation of RAI therapy, until the effects of radiation become apparent.

Which instructions would the nurse provide to a patient undergoing radioactive iodine therapy in the outpatient setting? Select all that apply. a. Avoid preparing food for others. b. Gargle with warm water before meals. c. Launder personal towels, bed linens, and clothes separately at home. d. Avoid being close to pregnant women or children for seven days after therapy. e. Discontinue antithyroid drugs after radioactive iodine (RAI) therapy.

c. Immerse the patient in warm water. Immersing the patient in warm water is an intervention for active external rewarming. Administering humidified oxygen is an intervention for active internal rewarming. Interventions for passive rewarming include removing the patient's wet clothing and placing the patient under radiant lighting.

Which intervention does the nurse implement for the active external rewarming of a patient experiencing hypothermia? a. Administer humidified oxygen. b. Remove the patient's wet clothing. c. Immerse the patient in warm water. d. Place the patient under radiant lighting.

b. Nasogastric (NG) suction and NPO status Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and NPO status to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Enteral feedings will be used only for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is needed only with acute necrotizing pancreatitis and signs of infection. The pain will be treated with IV morphine because of the NPO status.

Which intervention would the nurse expect to include in the plan of care for a patient with acute pancreatitis who has recurrent vomiting? a. Immediate enteral feeding to prevent malnutrition b. Nasogastric (NG) suction and NPO status c. Initiate early prophylactic antibiotic therapy to prevent infection d. Administer acetaminophen (Tylenol) every four hours for pain relief

d. Providing brightly colored and attractive food Patients undergoing radiation therapy experience loss of appetite. Serving brightly colored and attractive food may increase the patient's appetite. Giving low-fiber foods can result in constipation in the patient. Radiation therapy causes skin irritation, which should be brought to the health care provider's notice. Increasing dairy products in the diet may not improve the patient's appetite.

Which intervention would the nurse include for a patient who is undergoing radiation therapy for pancreatic cancer? a. Recommending a low-fiber diet b. Ignoring persistent skin irritation c. Increasing dairy products in the diet d. Providing brightly colored and attractive food

a. Strict hand washing d. Daily skin care and oral hygiene f. Private room with a high-efficiency particulate air (HEPA) filter Strict hand washing and daily skin and oral hygiene must be done with neutropenia because the patient is predisposed to infection from the normal body flora, other people, uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. Daily nasal swabs are not appropriate. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4°F (38°C) or more, but temperature is not monitored every hour. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room.

Which interventions are appropriate to include in the plan of care of a patient who has developed neutropenia? Select all that apply. a. Strict hand washing b. Daily nasal swabs for culture c. Monitoring temperature every hour d. Daily skin care and oral hygiene e. Encouraging eating all foods to increase nutrients f. Private room with a high-efficiency particulate air (HEPA) filter

a. Anticipate paracentesis. d. Monitor fluid and electrolytes. e. Administer an albumin infusion. Management of ascites focuses on sodium restriction, diuretics, and fluid removal. The fluid and electrolytes should be closely monitored; an imbalance may lead to an increase in ascites. An albumin infusion may be used to help maintain intravascular volume and adequate urine output by increasing plasma colloid osmotic pressure. Paracentesis can be done to remove the ascitic fluid from the peritoneum. The amount of sodium restriction is based on the degree of ascites. The patient is usually not on restricted fluids unless severe ascites develops; however, high-fluid intake should be avoided.

Which interventions would the nurse expect in the treatment plan for a patient who is admitted to the hospital with ascites? Select all that apply. a. Anticipate paracentesis. b. Provide a high-sodium diet. c. Encourage high-fluid intake. d. Monitor fluid and electrolytes. e. Administer an albumin infusion.

b. Administer IV morphine. e. Encourage the patient to change positions frequently. Patients with pancreatitis may experience restlessness due to pain in the abdomen. The nurse should administer morphine, which is an analgesic and relieves pain. The nurse should encourage the patient to change positions frequently, which may help relieve the restlessness associated with acute pancreatitis. Abdominal massage will further aggravate the tenderness. Walking will also aggravate the pain. The nurse should not encourage water because patients with acute pancreatitis are on NPO status.

Which interventions would the nurse implement for a patient with acute pancreatitis who is restless and reports abdominal pain? Select all that apply. a. Massage the patient's abdomen. b. Administer IV morphine. c. Encourage the patient to go for a walk. d. Instruct the patient to drink more water. e. Encourage the patient to change positions frequently.

b. Encourage the patient to wash hands frequently. d. Advise the patient to notify the health care provider if a fever develops. e. Advise the patient to brush the teeth four times a day with a soft toothbrush. Neutropenia, or decreased neutrophil count, increases the risk of developing infection. Therefore measures should be taken to prevent infections. The self-care instructions provided by the nurse should include frequent hand washing to prevent transmission of germs. Brushing the teeth four times a day with a soft toothbrush prevents the risk of oral infections. Fever is an emergency situation in cases of neutropenia and should be immediately reported to the health care provider. Eating raw eggs and staying in crowded areas increase the risk of acquiring infections and should be avoided.

Which interventions would the nurse include in the discharge teaching for a patient with neutropenia? Select all that apply. a. Encourage the patient to eat raw eggs. b. Encourage the patient to wash hands frequently. c. Encourage the patient to frequent crowded areas. d. Advise the patient to notify the health care provider if a fever develops. e. Advise the patient to brush the teeth four times a day with a soft toothbrush.

d. Hypertension Hypertension is an early sign of cyanide poisoning. Seizures and diarrhea are not signs associated with cyanide poisoning. Bradypnea is a late sign of cyanide poisoning.

Which is as an early sign of cyanide poisoning? a. Seizures b. Diarrhea c. Bradypnea d. Hypertension

d. Oral contraceptive use Oral contraceptives affect cholesterol production, thereby resulting in gallbladder cholesterol saturation, which causes gallbladder diseases such as cholelithiasis. Antibiotics, vasodilators, and anticholinergics do not affect cholesterol production and metabolism.

Which item reported in a patient's history increases the risk of developing cholelithiasis? a. Antibiotic use b. Vasodilator therapy c. Anticholinergic therapy d. Oral contraceptive use

c. Decreasing serum amylase level Serum amylase is a major indicator of pancreatic function and will be increased during acute pancreatitis. A decreasing serum amylase level indicates resolution of pancreatic inflammation. The nurse would evaluate the hemoglobin level if the acute pancreatitis were hemorrhagic in nature. Although serum bilirubin and serum alkaline phosphatase levels may be increased in acute pancreatitis, they are not most indicative of recovery from acute pancreatitis.

Which laboratory finding indicates resolution of a patient's acute pancreatitis? a. Increasing hemoglobin level b. Falling serum bilirubin level c. Decreasing serum amylase level d. Increasing serum alkaline phosphatase level

d. Thrombocytopenia AML leads to decreased production of platelets (thrombocytopenia), which increases bleeding time and leads to bruising. Neutropenia frequently occurs as a complication of chemotherapy and would increase risk for infection but would not be typical in untreated AML and would not be associated with increased bruising. Since bone marrow production of red blood cells is reduced in leukemia, anemia rather than polycythemia would be expected. Lymphocytosis may occur with acute lymphocytic leukemia but would not be expected in a patient with AML.

Which laboratory finding will the nurse expect after assessing a patient with acute myelogenous leukemia (AML) who has multiple bruises? a. Neutropenia b. Polycythemia c. Lymphocytosis d. Thrombocytopenia

d. Increased levels of triglycerides Acute pancreatitis attacks are associated with increased blood levels of triglycerides, resulting in hypertriglyceridemia. Acute pancreatitis is not associated with increased levels of sodium, potassium, or calcium. Increased levels of sodium can be associated with hypertension. Calcium is likely to be low, not high, in pancreatitis. Increased potassium levels are associated with cardiac dysrhythmias.

Which laboratory finding would indicate a patient's worsening pancreatic function? a. Increased levels of sodium b. Increased levels of calcium c. Increased levels of potassium d. Increased levels of triglycerides

b. Antithrombin III (AT III) levels c. Fibrinogen and platelet levels d. Protein C and protein S levels The laboratory report of a patient with acute DIC disorder may show reduced plasminogen levels due to imbalance in the coagulation system. The other results that are indicative of acute DIC include reduced antithrombin III (AT III) levels, reduced fibrinogen and platelet levels, and reduced protein C and protein S levels. Elevated FSPs and elevated D-dimers (cross-linked fibrin fragments) are also indicative of acute DIC disorder.

Which laboratory levels may be decreased in acute disseminated intravascular coagulation (DIC)? Select all that apply. a. Fibrin split products (FSPs) b. Antithrombin III (AT III) levels c. Fibrinogen and platelet levels d. Protein C and protein S levels e. D-dimers (cross-linked fibrin fragments

a. Increased bilirubin levels b. Increased serum iron levels c. Increased reticulocyte level Thalassemia major is characterized by the presence of increased bilirubin levels, serum iron levels, and reticulocyte level. Thalassemia major is also characterized by the presence of decreased mean corpuscular volume and total iron-binding capacity.

Which laboratory report findings support the nurse's conclusion that a patient has thalassemia major? Select all that apply. a. Increased bilirubin levels b. Increased serum iron levels c. Increased reticulocyte level d. Increased mean corpuscular volume e. Increased total iron-binding capacity

a. Hemoglobin value is 9 g/dL. c. Bleeding time is 20 minutes. e. Levels of megakaryocytes are elevated. The normal hemoglobin value is in the range of 12 to 13 g/dL. Therefore hemoglobin value of 9 g/dL is a result of thrombocytopenia. Thrombocytopenia is deficiency of platelets in the blood. The normal bleeding time is in the range of 3 to 10 minutes. Because platelets are involved in clotting, a deficiency of platelets increases the bleeding time. A bleeding time of 20 minutes is due to deficiency of platelets. When thrombocytopenia is caused by the destruction of platelets, the megakaryocyte count will be normal or increased in bone marrow examination. Thrombocytopenia is associated with a reduced hemoglobin level in the patient. The normal range of platelet count is in the range of 150,000 to 450,000/µL, so a platelet count of 200,000/ µL is normal. The normal hematocrit value is in the range of 42% to 54%.

Which laboratory result indicates thrombocytopenia? Select all that apply. a. Hemoglobin value is 9 g/dL. b. Platelet count is 200,000/µL. c. Bleeding time is 20 minutes. d. Hematocrit value is 42%. e. Levels of megakaryocytes are elevated.

c. Platelets 20,000/µL Thrombocytopenia means that there are low levels of circulating platelets. A platelet count below 150,000/ µL is considered low. As such, a platelet count of 20,000/µL is consistent with a diagnosis of thrombocytopenia. A normal hemoglobin level is 12 to 17 g/dL, depending on the sex of the patient. Hemoglobin levels of 13 g/dL and 16 g/dL are normal.

Which laboratory result is consistent with a diagnosis of thrombocytopenia? a. Hemoglobin 13 b. Hemoglobin 16 c. Platelets 20,000/µL d. Platelets 1,000,000/µL

d. Decreased protein C and S Multiple traumatic injuries are predisposing factors for the development of DIC disorder. The presence of blood in the urine and feces is a bleeding manifestation associated with DIC. The nurse expects decreased protein C and S levels in the laboratory report of this patient due to depletion of clotting factors. The nurse finds elevated D-dimers in the laboratory report of patient with DIC disorder. Increased hematocrit is found in the laboratory report of a patient with polycythemia vera. Reduced platelet count may be found in a patient with DIC disorder.

Which laboratory result may be found in patients with disseminated intravascular coagulation (DIC) disorder? a. Decreased D-dimers b. Increased hematocrit c. Increased platelet count d. Decreased protein C and S

c. A deficiency of granulocytes e. Inefficiently functioning platelets MDS commonly manifests as infection and bleeding caused by inadequate numbers of ineffective functioning circulating granulocytes or platelets. Red blood cells and platelets are decreased. Clotting factors are not affected by MDS.

Which laboratory results would the nurse expect to find when assessing a patient with myelodysplastic syndrome (MDS)? Select all that apply. a. An excess of platelets b. An excess of red blood cells c. A deficiency of granulocytes d. A deficiency of clotting factors e. Inefficiently functioning platelets

b. Peripheral blood smear Fragmented erythrocytes or schistocytes are indicative of partial occlusion of small vessels by fibrin thrombi. Peripheral blood smear test detects the presence of fragmented erythrocytes. Factor assays, soluble fibrin monomer, and FSPs tests do not detect the presence of fragmented erythrocytes; however, they are useful in determining the degree of fibrinolysis.

Which laboratory test can confirm the presence of fragmented erythrocytes in a patient suspected of having acute disseminated intravascular coagulation (DIC)? a. Factor assays b. Peripheral blood smear c. Soluble fibrin monomer d. Fibrin split products (FSPs)

b. Presence of lymphoblasts in cerebrospinal fluid c. Presence of hypercellular bone marrow with lymphoblasts Acute lymphocytic leukemia is characterized by lymphoblasts in cerebrospinal fluid and hypercellular bone marrow with lymphoblasts. Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts. Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.

Which laboratory test results are consistent with a patient's diagnosis of acute lymphocytic leukemia (ALL)? Select all that apply. a. Presence of increased number of myeloblasts b. Presence of lymphoblasts in cerebrospinal fluid c. Presence of hypercellular bone marrow with lymphoblasts d. Presence of accumulated small, mature-appearing lymphocytes e. Excessive development of mature neoplastic granulocytes in the bone marrow

d. Bone marrow examination Bone marrow examination is performed to rule out production problems such as leukemia, aplastic anemia, and other myeloproliferative disorders as the cause of thrombocytopenia. Therefore to confirm that the absence or decreased number of megakaryocytes to be the cause of thrombocytopenia, bone marrow examination will be done. PT will be tested to assess secondary hemostasis. A peripheral blood smear will be done to distinguish immune thrombocytopenic purpura (ITP) from congenital disorders. C serotonin release assay assists with the diagnosis of ITP.

Which laboratory test would provide information about the number of megakaryocytes in a patient with thrombocytopenia? a. Prothrombin time (PT) b. Peripheral blood smear c. 14C serotonin release assay d. Bone marrow examination

c. Prothrombin time Prothrombin time is normal; there is no involvement of extrinsic system. Partial thromboplastin time is prolonged because of deficiency in intrinsic clotting system factor. Bleeding time is prolonged because of structurally defective platelets. There will be a reduction of von Willebrand factor (vWF).

Which laboratory test would the nurse anticipate being normal in a patient with von Willebrand disease? a. Factor assays b. Bleeding time c. Prothrombin time d. Partial thromboplastin time

c. 26 to 42 days The average incubation period of the hepatitis E virus is 26 to 42 days. The average incubation period of the hepatitis A virus is 28 days. The average incubation period of the hepatitis C virus is 56 days. The average incubation period of hepatitis B is 56 to 96 days.

Which length of time is the average incubation period of the hepatitis E virus? a. 28 days b. 56 days c. 26 to 42 days d. 56 to 96 days

a. Acute lymphocytic leukemia (ALL) ALL is most commonly seen in children. AML is more commonly seen in adults. CLL is commonly seen in older adults. CML is most commonly seen in older adults.

Which leukemia is most commonly seen in children? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)

d. 110 mcg/24 hr Urine cortisol levels higher than 100 mcg/24 hr indicates a high urinary cortisol level, which is observed in Cushing syndrome.

Which level of urine cortisol in a 24-hour period indicates Cushing syndrome? a. 50 mcg/24 hr b. 70 mcg/24 hr c. 90 mcg/24 hr d. 110 mcg/24 hr

c. Cervical Hodgkin's lymphoma originates in cervical lymph nodes in 60% to 70% of patients. The mediastinal lymph nodes are the second most common location for Hodgkin's lymphoma. Hodgkin's lymphoma also may occur in the axillary and inguinal lymph nodes.

Which lymph nodes are most commonly affected in Hodgkin's lymphoma? a. Axillary b. Inguinal c. Cervical d. Mediastinal

b. Cyanosis of the extremities Ineffective peripheral tissue perfusion and acute pain are the nursing diagnoses related to a patient with chronic DIC disorder. The priority nursing intervention while caring for the patient is to examine for cyanosis of the extremities. Cyanosis is related to the widespread clotting that occurs along with thrombi or emboli and impairs tissue perfusion. Bleeding causes a drop in BP. Elevation in BP is not associated with DIC. In DIC, bowel sounds would be decreased due to thrombotic occlusion of blood vessels. PT is prolonged in a patient with DIC disorder.

Which manifestation would the nurse monitor for in a patient with chronic disseminated intravascular coagulation (DIC) disorder? a. Hyperactive bowel sounds b. Cyanosis of the extremities c. Elevation in BP d. Decreased prothrombin time (PT)

c. Abdominal girth Paracentesis involves the removal of fluid from the abdominal cavity. A large-bore needle connected to tubing is inserted by the health care provider into the distended abdomen. The other end of the tubing also has a large-bore needle, which is inserted into a vacuum bottle. The vacuum bottle is then held below the level of the abdomen, facilitating gravity-flowed removal of the ascites. Several bottles of fluid can be removed, with the result measured by reduction in abdominal girth. Cardiac output may improve after paracentesis, but it is unlikely that this measurement needs to be recorded. Paracentesis has no major effect on BP. Likewise, intake and output continue to be monitored to account for the paracentesis fluid, but these are not as informative as abdominal girth.

Which measurement would provide the most specific information about the outcome of a paracentesis for a patient who has ascites? a. Cardiac output b. BP c. Abdominal girth d. Intake and output

c. Rapid destruction of a large volume of cancer cells following chemotherapy TLS is due to massive cancer cell destruction following chemotherapy. When the cells are killed, they release their intracellular contents including uric acid, potassium, and phosphorus. This is also often accompanied by an increase in circulating white blood cells. Poor nutritional intake and anorexia, immunocompromise and risk for infection, and fluid and electrolyte imbalance are also complications of chemotherapy, but are not the mechanisms for TLS.

Which mechanism is responsible for tumor lysis syndrome (TLS) in a patient with Burkitt's lymphoma who just began treatment? a. Poor nutritional intake related to chemotherapy-induced anorexia b. Immunocompromised state due to chemotherapy-induced leukopenia c. Rapid destruction of a large volume of cancer cells following chemotherapy d. Fluid and electrolyte imbalances due to side effects of chemotherapy

c. Targets BCR-ABL protein Imatinib is a newer therapeutic agent used as targeted therapy. It acts by targeting BCR-ABL protein and killing the abnormal CML cells without damaging normal cells. Other chemotherapeutic medications treat leukemia by inhibiting angiogenesis, inhibiting cell proliferation, and causing DNA fragmentation.

Which mechanism of action for imatinib makes it effective in treating chronic myelogenous leukemia (CML)? a. Inhibits angiogenesis b. Inhibits cell proliferation c. Targets BCR-ABL protein d. Causes deoxyribonucleic acid (DNA) fragmentation

c. Pegvisomant Pegvisomant is a growth hormone antagonist, which reduces the effect of growth hormone in the body by blocking the hepatic production of insulin-like growth factor1. Lanreotide is a long-acting somatostatin analog, which is administered IM every four weeks in the treatment of acromegaly. Cabergoline may be administered alone or along with somatostatin analogs; it acts by reducing the secretions of growth hormone from the tumor. Bromocriptine is a dopamine antagonist that helps reduce the secretion of growth hormone from the tumor.

Which medication blocks the hepatic production of insulin-like growth factor-1 in a patient with acromegaly? a. Lanreotide b. Cabergoline c. Pegvisomant d. Bromocriptine

d. Hydromorphone (Dilaudid) via patient-controlled analgesia (PCA) During an acute sickle cell crisis, optimal pain control usually includes large doses of continuous (rather than PRN) opioid analgesics along with breakthrough analgesia, often in the form of PCA. Morphine and hydromorphone are the drugs of choice. Acetaminophen is appropriate for minor pain or fever, not for severe pain. Meperidine is contraindicated because high doses can lead to the accumulation of a toxic metabolite, normeperidine, which can cause seizures.

Which medication is most appropriate for the nurse to administer to a patient in acute sickle cell crisis who reports a pain level of 10? a. Acetaminophen (Tylenol) oral tablets every six hours. b. Oral morphine tablets, every four hours, PRN c. IV meperidine (Demerol), every four hours, PRN d. Hydromorphone (Dilaudid) via patient-controlled analgesia (PCA)

a. Prednisone Prednisone is included in combination chemotherapy for advanced-stage Hodgkin's lymphoma. Methotrexate is used for treatment of some leukemias and non-Hodgkin's lymphoma. Mitoxantrone is used for treatment of some leukemias and for non-Hodgkin's lymphoma. Fludarabine is used to treat some leukemias and for non-Hodgkin's lymphoma.

Which medication may be included in the chemotherapy regimen for a patient with advanced-stage Hodgkin's disease? a. Prednisone b. Methotrexate c. Mitoxantrone d. Fludarabine

b. Eltrombopag Eltrombopag is a thrombopoietin receptor agonist that acts by increasing platelet production. Danazol is an androgen that acts by increasing CD4 T cells. Tranexamic acid is an antifibrinolytic drug that acts by inhibiting plasminogen activation in the fibrin clot. Desmopressin acetate is a synthetic analog of vasopressin that acts on platelets and endothelial cells to release von Willebrand factor (vWF).

Which medication may benefit a patient with immune thrombocytopenic purpura (ITP) by increasing the platelet production? a. Danazol b. Eltrombopag c. Tranexamic acid d. Desmopressin acetate

d. Calcium gluconate Jerking movements, tingling around the lips, and irritability are symptoms of tetany, which is caused by hypocalcemia. When calcium levels drop, the salt form of calcium is administered; therefore the nurse expects the health care provider to prescribe calcium gluconate. Insulin is an antidiabetic drug and is prescribed in case of hyperglycemia. Vitamin K is an anticoagulant and is administered to patients with coagulation abnormalities. Cholestyramine belongs to the bile acid sequestrant and is prescribed to remove bile from the body through the feces.

Which medication would the nurse anticipate will be prescribed for a patient with pancreatitis who reports tingling around the lips? a. Insulin b. Vitamin K c. Cholestyramine d. Calcium gluconate

d. Administer a broad-spectrum IV antibiotic. The first nursing intervention for a febrile neutropenic patient is to administer a broad-spectrum antibiotic by IV route within one hour. Because of the rapid lethal effects of infection, this should be done even before obtaining cultures to determine a specific causative organism. Administration of a broad-spectrum antibiotic by the IV route is preferred to oral antibiotic for initial management because it is the faster administration method.

Which nursing action is the priority when providing care for neutropenic patient admitted with a febrile episode? a. Administer an oral antibiotic. b. Obtain cultures of the throat. c. Obtain blood cultures from two sites. d. Administer a broad-spectrum IV antibiotic.

d. Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool Vigorous coughing, sneezing, and straining at stool may result in CSF leakage after transsphenoidal hypophysectomy. The patient should lie in an elevated position, with the head of the bed at a 30-degree angle, as opposed to lying in the supine position. Tooth brushing should be avoided for a minimum of 10 days to protect the suture line. Reporting clear nasal discharge to the health care provider is important because elevated glucose levels in the discharge indicate CSF leakage; however, this intervention does not prevent the leakage of CSF.

Which nursing action would prevent the leakage of cerebrospinal fluid (CSF) after a transsphenoidal hypophysectomy? a. Having the patient lie down in the supine position b. Ensuring oral hygiene in the patient by regular brushing c. Informing the health care provider about nasal drainage d. Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool

d. Assessing for signs of increased intracranial pressure (ICP) Because removal of a pituitary tumor (a hypophysectomy) involves entering the cranium, increased ICP is always a risk, especially in the immediate postoperative period. With this knowledge, assessment for increased ICP is a priority for the nurse. Maintaining patent IV access, monitoring the patient for increased temperature, and offering the bedpan frequently are all appropriate but secondary to assessing the patient for increased ICP.

Which nursing intervention is a priority for a patient recovering from hypophysectomy? a. Maintaining patent IV access b. Monitoring the patient for increased temperature c. Offering the bedpan or urinal at least every two to three hours d. Assessing for signs of increased intracranial pressure (ICP)

b. Monitoring fluid intake and output Polyuria and polydipsia are the major clinical manifestations of diabetes insipidus. Therefore strict monitoring of fluid intake and output is a priority nursing intervention. Diet education and finger-stick blood glucose measurements are not high-priority interventions for diabetes insipidus. Constipation can be a secondary problem resulting from dehydration.

Which nursing intervention is most important for a patient with diabetes insipidus? a. Providing dietary education b. Monitoring fluid intake and output c. Assessing for constipation every day d. Obtaining a finger-stick blood glucose level

c. Administration of oral or IV corticosteroids Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.

Which nursing intervention would be appropriate in the care of a patient diagnosed with immune thrombocytopenic purpura (ITP)? a. Administration of packed red blood cells b. Administration of clotting factors VIII and IX c. Administration of oral or IV corticosteroids d. Maintenance of reverse isolation and application of standard precautions

c. Applying direct pressure with ice at the joint A patient with hemophilia who experiences joint bleeding should have the involved joint totally immobilized. Pressure should also be applied with ice to prevent crippling deformities from hemarthrosis. Aspirin should not be given because it will further increase the bleeding. Physical therapy should be provided after the bleeding stops. Elevating the affected extremity does not stop bleeding in the joint.

Which nursing intervention would be helpful to a patient with hemophilia who experiences severe joint bleeding? a. Giving aspirin to the patient b. Providing physical therapy at the joint c. Applying direct pressure with ice at the joint d. Elevating the affected extremity of the patient

b. Monitor pupillary response and speech patterns. The nurse should monitor the pupillary response, speech patterns, and extremity strength to detect neurologic complications. The nurse should ensure the head of the bed is elevated at all times to a 30-degree angle to avoid pressure on the sella turcica and to decrease headaches, a frequent postoperative problem. The nurse must perform mouth care for the patient every four hours to keep the surgical area clean and free of debris. The nurse must notify the surgeon and send any clear nasal fluid to the laboratory to test for glucose.

Which nursing intervention would be included in the plan of care for a patient who underwent a transsphenoidal hypophysectomy? a. Place the patient in a supine position at all times. b. Monitor pupillary response and speech patterns. c. Perform mouth care every 12 hours. d. Test any clear nasal drainage for potassium.

c. Patient teaching related to levothyroxine A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine therapy are indicated in the treatment of hyperthyroidism.

Which nursing intervention would be included in the plan of care for a patient with a diagnosis of hypothyroidism? a. Providing a dark, low-stimulation environment b. Closely monitoring the patient's intake and output c. Patient teaching related to levothyroxine d. Patient teaching related to radioactive iodine therapy

b. Elevate the head of the bed to a 30-degree angle. Elevating the head of the bed to a 30-degree angle alleviates pressure on the sella turcica and thereby relieves the headache. Avoiding brushing the teeth for 10 days protects the suture line; it doesn't decrease a headache. Drainage on any dressings are checked for glucose, but to check for cerebrospinal fluid leakage, not to decrease a headache. Monitoring pupillary response and speech patterns checks help detect neurologic complications.

Which nursing intervention would be taken to provide relief to a patient who is complaining of a severe headache after a hypophysectomy? a. Teach the patient to avoid brushing teeth for at least 10 days. b. Elevate the head of the bed to a 30-degree angle. c. Check the drainage on the dressing for glucose. d. Monitor pupillary response and speech patterns

a. Positioning the head of the bed flat Once SIADH is diagnosed, the treatment is directed at the underlying causes. Positioning the head of the patient's bed flat enhances venous return to the heart and increases the left arterial filling pressure, thereby reducing the release of antidiuretic hormone (ADH). Ambulation is necessary to improve circulation the mobility of joints. Ambulation is not involved in promoting a reduction of ADH. Turning and positioning the patient frequently and encouraging range-of-motion exercises maintain skin integrity and joint mobility, especially in bedridden patients; these interventions do not promote a reduction of ADH.

Which nursing intervention would promote a reduction in the release of antidiuretic hormone (ADH) in a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Positioning the head of the bed flat b. Encouraging the patient to ambulate c. Changing the patient position frequently d. Instructing the patient to perform range-of-motion exercises

a. Assessing for tetany b. Monitoring vital signs d. Assessing the patient every two hours on the first postoperative day Postoperative nursing interventions that are appropriate for a patient after a thyroidectomy include assessing for tetany, monitoring vital signs, and assessing the patient every two hours on the first postoperative day for hemorrhage and tracheal compression. The nurse should monitor calcium levels, not potassium levels. The nurse should place the patient in a semi-Fowler's position to reduce swelling and edema in the neck area. Sandbags or pillows may be used to support the head or neck.

Which nursing interventions would be included in the plan of care for a patient recovering from a thyroidectomy? Select all that apply. a. Assessing for tetany b. Monitoring vital signs c. Monitoring potassium levels d. Assessing the patient every two hours on the first postoperative day e. Placing the patient in a high Fowler's position

b. Administer analgesics for postoperative pain. d. Assess for signs of tetany. e. Assess the patient every two hours for signs of bleeding Nursing interventions after a thyroidectomy are important to prevent complications, such as airway obstruction. These interventions include controlling pain with medication; assessing for signs of tetany (i.e., tingling in toes, fingers, and around the mouth, Trousseau's sign, and Chvostek's sign); and assessing the patient every two hours for signs of bleeding and tracheal compression. Calcium levels should be monitored, not potassium levels. The patient should be placed in a semi-Fowler's position, not supine, with the head supported with pillows.

Which nursing interventions would the nurse implement for a patient status after a subtotal thyroidectomy? Select all that apply. a. Monitor potassium levels. b. Administer analgesics for postoperative pain. c. Place the patient supine with the head supported on pillows. d. Assess for signs of tetany. e. Assess the patient every two hours for signs of bleeding

a. Monitor intake and output. c. Ensure that IV calcium is available. e. Assess for numbness and tingling of the hands and mouth. Intake and output are assessed carefully because of the patient's risk for fluid imbalance. IV calcium gluconate or gluceptate should be readily available for administration because the postoperative parathyroidectomy patient is at risk for hypocalcemia, which can lead to life-threatening tetany. Numbness and tingling of the hands and mouth are signs of mild tetany. Babinski's sign is not assessed in postoperative parathyroidectomy patients. Chvostek's and Trousseau's signs are assessed to monitor for signs of tetany. Mobility, not bed rest, should be encouraged to promote bone calcification.

Which nursing inventions would be included in the plan of care for a patient who had a parathyroidectomy? Select all that apply. a. Monitor intake and output. b. Monitor for Babinski's sign. c. Ensure that IV calcium is available. d. Instruct the patient to maintain bed rest for 48 hours. e. Assess for numbness and tingling of the hands and mouth.

a. Patient A Cranial radiation therapy is given to a patient when the leukemia involves the central nervous system (CNS). This is commonly observed in patients who have acute lymphocytic leukemia, such as patient A. Acute myelogenous leukemia does not typically invade the CNS, and cranial radiation would not be anticipated for patient B. Chronic lymphocytic leukemia does not involve the CNS, and patient C will not require cranial radiation. Chronic myelogenous leukemia does not invade the CNS, so patient D will not need cranial radiation.

Which of these four patients is most likely to need teaching about cranial radiation therapy? a. Patient A b. Patient B c. Patient C d. Patient D

c. Rest the knee and pack in ice. d. Administer specific coagulation factor. a. Administer prescribed analgesic. b. Encourage mobilization as soon Acute nursing intervention for a hemophilic patient with a bleeding knee is to stop the topical bleeding by resting the knee and packing it in ice. The patient is administered specific coagulation factor to raise the level of deficient coagulation factor. Analgesics that do not contain aspirin or aspirin compounds are administered to reduce severe pain. The patient should be encouraged to mobilize the joint through range-of-motion exercises and physiotherapy as soon as bleeding ceases; however, weight bearing is avoided until all swelling has resolved and muscle strength has returned.

Which order would the nurse perform the interventions listed on the plan of care for a patient with hemophilia who developed bleeding after a fall? a. Administer prescribed analgesic. b. Encourage mobilization as soon as bleeding ceases. c. Rest the knee and pack in ice. d. Administer specific coagulation factor.

b. Release of tissue factor at the site of injury c. Abundant production of intravascular thrombin d. Conversion of fibrinogen to fibrin a. Deposition of platelets in capillaries and arterioles In DIC disorder, the tissue factor is released at the site of injury. Abundant intravascular thrombin, which is a powerful coagulant, is produced. It catalyzes the conversion of fibrinogen to fibrin and enhances platelet aggregation. Widespread fibrin and platelet deposition occurs in capillaries and arterioles, resulting in thrombosis. These events lead to MODS.

Which order would the nurse place the events associated with disseminated intravascular coagulation (DIC) disorder that lead to multiple organ dysfunction syndrome (MODS)? a. Deposition of platelets in capillaries and arterioles b. Release of tissue factor at the site of injury c. Abundant production of intravascular thrombin d. Conversion of fibrinogen to fibrin

c. Fluid intake Fluid intake should be monitored because there may be a chance of corticosteroid imbalance after surgery, which can cause dehydration. Temperature and oxygen saturation monitoring are not related to corticosteroid imbalance. Infections should be monitored during surgery.

Which parameter is monitored that would indicate a corticosteroid imbalance after surgery in a patient with Cushing syndrome? a. Temperature b. Infection c. Fluid intake d. Oxygen saturation

a. Fibrinogen levels e. Partial thromboplastin time (PTT) The nurse should assess the parameters such as fibrinogen levels and PTT while monitoring a patient for the development of DIC disorder. Hemoglobin levels, RBC count, and WBC count are not altered in a patient with DIC. Therefore the nurse need not assess these parameters in a patient with DIC.

Which parameters would the nurse assess while monitoring a patient for the development of disseminated intravascular coagulation (DIC) disorder? Select all that apply. a. Fibrinogen levels b. Hemoglobin levels c. Red blood cell (RBC) count d. White blood cell (WBC) count e. Partial thromboplastin time (PTT)

a. Patient A D-penicillamine is an antidote for copper, which is used in the treatment of Wilson's disease. Patient A has acute pancreatitis, which is manifested with abdominal pain and muscle spasms. Patients with acute pancreatitis are prescribed antispasmodics, analgesics, and carbonic anhydrase inhibitors. Patient B has chronic pancreatitis and is prescribed Creon, which is a synthetic pancreatic enzyme to counteract enzyme deficiency. Cirrhosis is associated with pruritus; therefore Patient C is given hydroxyzine to relieve skin irritation. Chronic hepatitis B is an infectious disease caused by the hepatitis B virus. Therefore adefovir, a nucleotide and nucleoside analog, is prescribed to Patient D.

Which patient has a medication prescribed that the nurse would question? a. Patient A b. Patient B c. Patient C d. Patient D

d. History of hepatitis B infection Rituximab treatment can reactivate hepatitis B, and the health care provider will need to consider whether rituximab is appropriate for this patient. Anemia may occur with non-Hodgkin's lymphoma; a hematocrit of 34% is not a contraindication to rituximab treatment and does not require immediate treatment. Penicillin allergy is not a contraindication to rituximab treatment. The creatinine level of 0.7 mg/d L is in the normal range.

Which patient information is most important for the nurse to discuss with the health care provider prior to administration of the prescribed rituximab to a patient with non-Hodgkin's lymphoma? a. Hematocrit of 34% b. Allergy to penicillin c. Creatinine level of 0.7 mg/dL d. History of hepatitis B infection

c. Laboratory finding of low platelet count Objective data includes diagnostic findings, such as a low platelet count. A patient report of impotence would be included in subjective data since this information is not objectively verified by the nurse. Patient descriptions of symptoms, such as prolonged menstrual cycles, are included in subjective data. Since family history is obtained from the patient and not observed or verified by the nurse, this information is documented as subjective.

Which patient information will be included when documenting objective data after the nurse has done the admission assessment for a patient with leukemia? a. Patient report of impotence b. Patient history of prolonged menses c. Laboratory finding of low platelet count d. Family history of Klinefelter syndrome

d. A 35-year old female adult TTP is seen primarily in adults between 20 and 50 years of age, with a slight female predominance. Therefore a 35-year old female adult is more likely to have TTP. A 12- year-old male child, a 30-year old male adult, and a 10-year-old female child are less likely to have TTP than a 35-year old female adult.

Which patient is most likely to experience thrombotic thrombocytopenic purpura (TTP)? a. A 12-year-old male child b. A 30-year old male adult c. A 10-year-old female child d. A 35-year old female adult

b. Patient who received a tetanus vaccine seven years ago and has already received two vaccines Because the tetanus vaccine booster is recommended when the patient has not been vaccinated in the past five years and has had fewer than three immunizations total, the patient who received a vaccine seven years ago and has received two previous vaccinations will need repeat vaccination. The patient who received tetanus vaccination two months ago is considered immune and does not need further vaccination. The patient who has received four previous vaccinations, with the most recent vaccination four years ago does not need revaccination. The patient who received a vaccination two years ago is current with tetanus immunization and does not need another vaccination.

Which patient with an open wound seen in the emergency department requires a tetanus vaccine? a. Patient who received a tetanus vaccine two months ago in the wellness clinic b. Patient who received a tetanus vaccine seven years ago and has already received two vaccines c. Patient who received a tetanus vaccine four years ago and has already received four vaccines d. Patient who received a tetanus vaccine two years ago and has already received three vaccines

c. Patient C The Philadelphia chromosome is present in over 90% of patients with chronic myelogenous leukemia. It is considered an important indicator of continuing or recurrent chronic myelogenous leukemia after treatment. Hypercellular bone marrow with lymphoblasts indicates acute lymphocytic leukemia. Chronic myelogenous leukemia is characterized by anemia with low red blood cell count, hemoglobin, and hematocrit. Acute myelogenous leukemia is associated with high lactic dehydrogenase (LDH) levels.

Which patient's diagnostic findings are consistent with chronic myelogenous leukemia (CML)? a. Patient A b. Patient B c. Patient C d. Patient D

d. Patient D The condition in which tumor cells cannot be detected by morphologic study but can be identified by molecular testing is known as minimal residual disease. If the molecular studies of a patient are negative for residual leukemia, then it indicates molecular remission. Partial remission occurs when there is a normal peripheral blood smear, but there is evidence of disease in the bone marrow. Complete remission is characterized by normal bone marrow and peripheral blood smear, with no evidence of disease upon physical examination.

Which patient's diagnostic follow-up studies after treatment for leukemia indicate minimal residual disease? a. Patient A b. Patient B c. Patient C d. Patient D

c. Edematous pancreas Mild pancreatitis is manifested by edema. The severe form of pancreatitis is manifested by organ failure, necrosis, and sepsis of the pancreas.

Which physiologic condition is consistent with mild pancreatitis? a. Pancreatic failure b. Pancreatic necrosis c. Edematous pancreas d. Sepsis of the pancreas

c. Excessive secretion of adrenocorticosteroid hormones Cushing syndrome results from excessive secretion of adrenocorticosteroid hormones, usually caused by pituitary gland tumors or carcinoma of the adrenal glands. It is also the result of excessive steroid intake for other medical conditions or nonmedical use (e.g., sports). Cushing syndrome is not directly related to liver function or renal failure. It is caused by excessive, not decreased, amounts of adrenocorticosteroid hormones.

Which physiologic factor is related to the development of Cushing syndrome? a. Liver dysfunction b. Chronic renal failure c. Excessive secretion of adrenocorticosteroid hormones d. Decreased secretion of adrenocorticosteroid hormones

a. Maintain a low-fat diet. b. Monitor for any bleeding. d. Place the patient in the Sims' position. After cholecystectomy, it is important to follow dietary restrictions. A diet low in fat decreases the workload of the liver. Bleeding is a complication after the procedure; hence the nurse should monitor for it. It is important to position the patient in the Sims' position to facilitate gas pockets moving away from the diaphragm. Encourage deep breathing along with movement and ambulation to help to expand the lungs and promote ventilation. The patient need not be put in the Trendelenburg position; it will cause abdominal discomfort and does not contribute to recovery.

Which postoperative care would the nurse perform for a patient after a cholecystectomy? Select all that apply. a. Maintain a low-fat diet. b. Monitor for any bleeding. c. Instruct to avoid deep breathing. d. Place the patient in the Sims' position. e. Place patient in the Trendelenburg position.

b. Constipation Iron supplements, such as ferrous gluconate, reduce peristalsis and result in constipation. Ferrous gluconate does not reduce BP and does not result in hypotension. Ferrous gluconate can cause gastrointestinal bleeding and black, tarry stools. Ferrous gluconate does not cause fluid accumulation in the peritoneal cavity or abdominal swelling.

Which potential side effect would the nurse include when teaching a patient about the administration of ferrous gluconate? a. Hypotension b. Constipation c. Clay-colored stool d. Abdominal swelling

a. Albumin Acute pancreatitis may cause shock, which is manifested by decreased volume of body fluids and reduced circulatory volume, which results in decreased BP. Albumin is a plasma volume expander that should be administered to help restore the circulatory volume. Octreotide is a drug used to treat esophageal varices in patients with liver cirrhosis. Cyclosporine is a calcineurin inhibitor used as an immunosuppressive drug in patients with liver transplantation. Acetazolamide is a carbonic anhydrase inhibitor used to decrease the volume and bicarbonate concentration of pancreatic secretion in patients with acute pancreatitis.

Which prescribed treatment would the nurse expect to administer to a patient with pancreatitis who has a BP of 80/70 mm Hg? a. Albumin b. Octreotide c. Cyclosporine d. Acetazolamide

c. To prevent cerebrospinal fluid leakage Vigorous coughing and sneezing cause leakage of the cerebrospinal fluid, which increases the risk of developing meningitis. Seizures are changes in the brain's electrical activity; they are not triggered by vigorous coughing and sneezing. Postoperative headache can be avoided by raising the head of the patient's bed to a 30-degree angle. Pupillary response would not be changed due to coughing and sneezing. Pupillary responses are monitored to detect neurologic complications.

Which rationale would the nurse give a patient who had a hypophysectomy to avoid vigorous coughing and sneezing? a. To avoid seizures b. To avoid a headache c. To prevent cerebrospinal fluid leakage d. To prevent pupillary changes

a. To prevent infiltration of ALL into the brain ALL is commonly associated with infiltration of leukemic cells into the central nervous system (CNS), and intrathecal chemotherapy is used to reduce the chance of CNS involvement. Pain may occur with ALL but is not treated with intrathecal chemotherapy. Immune modulators may be given as part of treatment for leukemia but are not administered through the intrathecal route. Intrathecal chemotherapy does not decrease infection risk while patients are being treated for ALL.

Which response will the nurse make when a patient who is being treated for acute lymphocytic leukemia (ALL) asks, "Why do I need intrathecal chemotherapy?" a. To prevent infiltration of ALL into the brain b. To assist with management of pain caused by ALL c. To help boost immune response during ALL treatment d. To decrease the risk of infection during ALL treatment

c. Alcohol abuse Cirrhosis is highly correlated with alcohol abuse and chronic hepatitis C. Polypharmacy, drug abuse, and hepatitis A are not linked to cirrhosis.

Which risk factor is most commonly associated with cirrhosis? a. Hepatitis A b. Polypharmacy c. Alcohol abuse d. IV drug abuse

c. Organize untrained community members to assist others at the scene. Rationale A CERT is a team of community volunteers trained to provide basic help and to organize others to offer assistance before first responders and medical personnel arrive at a disaster scene. CERT volunteers do not have the education or experience to triage. CERT volunteers are not defined as first responders since they are volunteers and do not provide medical care. CERT team members are not health care providers and would not offer advanced medical care.

Which role does a community emergency response team (CERT) fulfill in a disaster? a. Initiate triage decision making at the disaster site. b. Provide basic medical care at the site of the disaster. c. Organize untrained community members to assist others at the scene. d. Give advanced medical care at the disaster scene prior to hospital transfer.

b. Promotes red blood cell (RBC) maturation Folic acid promotes maturation of RBCs. Ascorbic acid aids in the absorption of iron. Iron and pyridoxine promote hemoglobin synthesis. Copper helps to mobilize iron from tissue to plasma.

Which role does folic acid play in erythropoiesis? a. Aids in absorption of iron b. Promotes red blood cell (RBC) maturation c. Promotes hemoglobin synthesis d. Aids in mobilization of iron from tissue to plasma

a. Weight gain c. Altered mental status d. Fluctuating sodium levels DDAVP is a synthetic analog of the natural pituitary hormone, arginine vasopressin, an antidiuretic hormone (ADH) that affects renal water conservation. Assessing the weight of the patient when the patient is using desmopressin acetate is important because weight gain is a side effect of desmopressin acetate. The use of desmopressin acetate may also alter the mental status of the patient, causing hallucinations and depression. Desmopressin acetate may cause fluctuations in sodium levels. Therefore regular assessment of sodium levels of the patient is necessary. Reduced skin turgor and dried mucous membranes are the signs of severe dehydration, which are not side effects of desmopressin acetate.

Which side effects would the nurse assess in a patient who is on desmopressin acetate (DDAVP)? Select all that apply. a. Weight gain b. Reduced skin turgor c. Altered mental status d. Fluctuating sodium levels e. Dry mucous membranes

c. Ischemic tissue necrosis Ischemic tissue necrosis, such as gangrene, is a sign of microvascular thrombosis associated with the integumentary system. Paralytic ileus is associated with the gastrointestinal (GI) system. ECG changes and venous distention are associated with the cardiovascular system.

Which sign of microvascular thrombosis observed in a patient with disseminated intravascular coagulation (DIC) disorder is associated with the integumentary system? a. Paralytic ileus b. Venous distention c. Ischemic tissue necrosis d. Electrocardiogram (ECG) changes

c. "With lymphoma, there are fewer circulating abnormal cells." Abnormal lymphocytes are found mostly in the lymph nodes and tissues in a patient with lymphoma, and there are fewer abnormal cells in the circulation. Abnormal lymphocytes are more likely to be found in the peripheral circulation with lymphocytic leukemias than with lymphoma. A defining characteristic of lymphoma is proliferation of abnormal lymphocytes in the nodes, leading to enlargement of the nodes. Granulocyte proliferation leads to myelogenous leukemias but not to lymphoma.

Which statement about lymphoma will the nurse make when a patient asks about the difference between lymphocytic leukemia and lymphoma? a. "Lymphoma involves mostly peripheral lymphocytosis." b. "With lymphoma, there is very minimal nodal involvement." c. "With lymphoma, there are fewer circulating abnormal cells." d. "Lymphoma involves proliferation of granulocytes or their precursors."

c. "I will include high-fat foods in the patient's dietary plan." Patients with acute pancreatitis should be provided with food that does not stimulate the pancreas; therefore high-fat food substances should not be given to the patient. Patients with pancreatitis are given nasojejunal tube feeding. Patients with pancreatitis have malfunctioning of the pancreas and therefore do not metabolize fats. If fat-rich substances or IV lipids are given, then the blood triglyceride level may rise. Therefore the nurse should monitor the patient's blood triglyceride levels. To avoid burden on the pancreas, feedings should be given frequently in small quantities.

Which statement by a student nurse indicates a need for further teaching about nutritional therapy in patients with acute pancreatitis? a. "I should feed the patient through a nasojejunal tube." b. "I will monitor the patient's blood triglyceride levels." c. "I will include high-fat foods in the patient's dietary plan." d. "I should give small quantities of food frequently to the patient."

a. "It is important that I brush my teeth every day." Tooth brushing should be avoided for 10 days to protect the suture line. Vigorous coughing and sneezing should be avoided to prevent cerebrospinal leakage. A severe headache may indicate cerebrospinal leakage into the sinuses and should be reported to the nurse. Straining with bowel movements may cause cerebrospinal leakage.

Which statement by the patient who is status post a transsphenoidal hypophysectomy indicates a need for further education? a. "It is important that I brush my teeth every day." b. "I should refrain from vigorous coughing and sneezing" c. "I should notify the nurse if I develop a severe headache." d. "I may need to take a stool softener so that I do not strain with having a bowel movement."

d. There is a lack of symptoms and a normal peripheral blood smear, but evidence of the disease is still present in bone marrow. Partial remission is characterized by a lack of symptoms and a normal peripheral blood smear, but evidence of disease in the bone marrow. Molecular remission indicates that all molecular studies are negative for residual leukemia. Minimal residual disease is defined as tumor cells that cannot be detected by morphologic examination but can be identified by molecular testing. In complete remission, there is no evidence of overt disease on physical examination, and the bone marrow and peripheral blood appear normal.

Which statement does the nurse identify as being true about partial remission after leukemia treatment? a. All molecular studies for residual leukemia are negative. b. Tumor cells cannot be detected by morphologic examination, but they are present in molecular testing. c. There is no evidence of overt disease on examination, and the bone marrow and peripheral blood are normal. d. There is a lack of symptoms and a normal peripheral blood smear, but evidence of the disease is still present in bone marrow.

d. Severe pounding headaches and profuse sweating are clinical features. Severe pounding headache and profuse sweating are clinical features of pheochromocytoma. Although drug therapy is administered during preoperative care to reduce complications, the primary treatment is surgery. The attack is provoked by many drugs including antihypertensives, opioids, radiologic contrast media, and tricyclic antidepressants, not antiepileptic medications. Epinephrine and norepinephrine levels rise in patients with pheochromocytoma.

Which statement is true about pheochromocytoma? a. The primary treatment is drug therapy. b. An attack is provoked by antiepileptic medications. c. Decreased levels of epinephrine and norepinephrine are observed. d. Severe pounding headaches and profuse sweating are clinical features.

b. Hemophilia can be treated by replacement therapy. Hemophilia decreases the clotting ability of the blood in a patient and can be treated by replacement therapy during acute phases of bleeding. Hemophilia is hereditary in nature. Hemophilia is an X-linked recessive genetic disorder. The most common form of hemophilia is hemophilia A.

Which statement is true regarding hemophilia? a. Hemophilia is not hereditary in nature. b. Hemophilia can be treated by replacement therapy. c. Hemophilia is an X-linked dominant genetic disorder. d. Hemophilia B is the most common form of hemophilia.

c. I will have work restrictions for six weeks after surgery." Laparoscopic cholecystectomy is a minimally invasive surgery that involves removal of the gallbladder. Postoperative pain is minimal, and the patient can resume his or her work within one week of the surgery. The procedure involves making small punctures into the abdomen through which an instrument called a laparoscope is inserted. The patient is discharged on the day of surgery or a day after it. The laparoscope has a camera attached to it, which is inserted through the punctures.

Which statement made by the patient indicates the need for further teaching about laparoscopic cholecystectomy? a. "Small punctures will be made in my abdomen." b. "I may be discharged the same day as the surgery." c. "I will have work restrictions for six weeks after surgery." d. "An instrument with a camera will be inside my abdomen."

c. "I should monitor the patient's blood glucose levels." e. "I should check the patient's body temperature for fever." Acute pancreatitis is associated with inflammation of the pancreas. Therefore to determine any damage to the β-cells of the islets of Langerhans, the nurse should monitor the patient's blood glucose levels. The nurse should check for fever, which is a manifestation of infection. The nurse's statements "I should monitor the patient's blood glucose levels" and "I should check the patient's body temperature" indicate effective learning. The nurse should not encourage the patient to tolerate pain. Limiting fluid intake can result in dehydration and constipation. Spider angioma is a sign of a manifestation of liver cirrhosis.

Which statements of the student nurse indicate effective learning about providing care to a patient with acute pancreatitis? Select all that apply. a. "I should encourage the patient to tolerate pain." b. "I should encourage the patient to limit fluid intake." c. "I should monitor the patient's blood glucose levels." d. "I should check for spider angioma on the patient's skin." e. "I should check the patient's body temperature for fever."

c. Right upper-quadrant pain radiating to the shoulder and scapula The pain of cholecystitis is in the region of the gallbladder (right upper quadrant), which is inflamed as a result of infection and irritation from bile. The pain may be referred to the right shoulder and scapula. Left-flank pain with intermittent exacerbations may be caused by renal calculi. Right lower-quadrant pain with rebound tenderness may be related to acute appendicitis, Crohn's disease, or peritonitis. Epigastric pain that intensifies when the patient is lying down may be related to gastroesophageal reflux disease or hiatal hernia.

Which subjective description of pain would the nurse expect from a patient who has cholecystitis? a. Left-flank pain with intermittent exacerbations b. Right lower-quadrant pain with rebound tenderness c. Right upper-quadrant pain radiating to the shoulder and scapula d. Epigastric-area pain that intensifies when the patient is lying down

b. Calcium Cholelithiasis occurs due to an imbalance in the system that maintains calcium, bile salts, and cholesterol in a solution form, thereby resulting in precipitation. Albumin, sodium, and globulin are not involved in the formation of cholelithiasis.

Which substance is involved in the development of cholelithiasis? a. Sodium b. Calcium c. Albumin d. Globulin

d. Transhepatic biliary catheter Open cholecystectomy involves the removal of the gallbladder through a right subcostal incision. A transhepatic biliary catheter can be used preoperatively in patients who will undergo an open cholecystectomy. A transhepatic biliary catheter is inserted for palliative care when inoperable liver, pancreatic, or bile duct carcinoma obstructs the bile flow. A laparoscope is an instrument inserted during laparoscopic procedures. Biliary stents and catheters with wire baskets are used during endoscopy.

Which surgical instrument is used preoperatively in a patient who will be undergoing an open cholecystectomy? a. Biliary stent b. Laparoscope c. Catheter with wire basket d. Transhepatic biliary catheter

c. Thrombotic thrombocytopenic purpura (TTP) TTP is caused due to the deficiency of plasma enzyme ADAMTS13. ITP is caused by decreased platelet production. Without the enzyme, unusually large amounts of von Willebrand factor will attach to activated platelets and promote platelet aggregation. Increased use of heparin causes HIT. Overstimulation of proteins involved in clotting factors can result in DIC.

Which syndrome is caused by the deficiency of plasma enzyme ADAMTS13? a. Immune thrombocytopenic purpura (ITP) b. Heparin-induced thrombocytopenia (HIT) c. Thrombotic thrombocytopenic purpura (TTP) d. Disseminated intravascular coagulation (DIC)

b. Autoimmune polyglandular syndrome Addison's disease is an autoimmune disorder caused by the destruction of adrenal tissue by antibodies. When it occurs along with other endocrine disorders, Addison's disease is called autoimmune polyglandular syndrome. Hashimoto's thyroiditis, multiple endocrine neoplasia syndrome, and SIADH are not associated with these conditions.

Which syndrome would be suspected in a patient who has Addison's disease along with other endocrine conditions? a. Hashimoto's thyroiditis b. Autoimmune polyglandular syndrome c. Multiple endocrine neoplasia d. Syndrome of inappropriate antidiuretic hormone (SIADH)

d. Cholelithiasis Cholelithiasis is the formation of stones in the gallbladder. The pain associated with cholelithiasis is called biliary colic. Cholangitis is inflammation of bile ducts. Inflammation of the gallbladder is called cholecystitis.

Which term is used for the formation of stones in the gallbladder? a. Biliary colic b. Cholangitis c. Cholecystitis d. Cholelithiasis

c. Urinary creatinine Pheochromocytoma is a disorder of the adrenal medulla; urinary creatinine is used to diagnose this disorder. Urinary cortisol, urine osmolality, and urinary aldosterone are used to diagnose Addison's disease.

Which test is more reliable to diagnose pheochromocytoma? a. Urinary cortisol b. Urine osmolality c. Urinary creatinine d. Urinary aldosterone

a. Warfarin b. Plasmapheresis c. Protamine sulfate In HIT, platelet count decreases and hemoglobin level remains normal. Warfarin is given to the patient when the platelet count reaches 150,000/μL. If there is severe clotting, then plasmapheresis is preferred to treat the patient to clear the plateletaggregating immunoglobulin G (IgG) from the blood. Protamine sulfate is given to interrupt the circulating heparin. Platelet transfusions would not be effective to treat HIT because this may enhance thromboembolic events. Heparin and low-molecularweight heparin should be discontinued because they may further potentiate thrombocytopenia.

Which therapies would the nurse expect to incorporate into the plan of care for a patient diagnosed with heparin-induced thrombocytopenia (HIT)? Select all that apply. a. Warfarin b. Plasmapheresis c. Protamine sulfate d. Platelet transfusion e. Low-molecular-weight heparin

a. Heparin Oral anticoagulants are administered in DIC to decrease bleeding episodes. Uncontrolled bleeding episodes indicate a chronic type of DIC and unresponsiveness to oral anticoagulants. Therefore heparin should be administered to maintain hemostasis. Therapy with blood products such as platelets, cryoprecipitates, and fresh frozen plasma are usually reserved for a patient with life-threatening hemorrhage.

Which therapy is appropriate for chronic disseminated intravascular coagulation (DIC)? a. Heparin b. Platelets c. Cryoprecipitate d. Fresh frozen plasma

c. Desmopressin acetate Desmopressin acetate is used to treat minor bleeding episodes and dental procedures. Tranexamic acetate is the antifibrinolytic used to stabilize the clot in patients with epistaxis and menorrhagia. Fresh frozen plasma is used as replacement therapy in treating hemophilia. Epsilon-aminocaproic acid is the antifibrinolytic used for clot stability in patients with difficult episodes of epistaxis and menorrhagia.

Which therapy would be beneficial for a patient who experiences a minor bleeding episode during a dental procedure? a. Tranexamic acetate b. Fresh frozen plasma c. Desmopressin acetate d. Epsilon-aminocaproic acid

d. Side effects of chemotherapy Since chemotherapy is the most likely initial treatment for early NHL, the nurse will plan on teaching about side effects associated with chemotherapy. Since lymph node swelling in the early stage of NHL is usually nontender, pain control options are not necessary to teach. A 66-year-old woman does not need information about how to preserve fertility. Patients with stage IA lymphoma do not have night sweats, which are a defining B characteristic in lymphoma.

Which topic will be included when teaching a 66-year-old woman who is starting treatment for stage 1A non-Hodgkin's lymphoma (NHL)? a. Options for pain control b. Ways to preserve fertility c. Management of night sweats d. Side effects of chemotherapy

c. Phenoxybenzamine Phenoxybenzamine is an α-adrenergic blocker that is used to control BP 10 to 14 days before surgery in a patient with pheochromocytoma. Carvedilol is an α-antagonist and β-blocker used to treat hypertension. Metyrosine decreases catecholamine production; it is prescribed to patients who are not ideal candidates for surgery. Propranolol is a βadrenergic blocker that is used to treat dysrhythmias and tachycardia during preoperative care of a patient with pheochromocytoma.

Which treatment is given to a patient with pheochromocytoma to control high BP before surgery? a. Carvedilol b. Metyrosine c. Propranolol c. Phenoxybenzamine

a. Rituximab c. External beam irradiation d. Single-agent chemotherapy e. Combination chemotherapy Indolent NHL may be treated with the monoclonal antibody rituximab, external beam irradiation, and with either single-agent or combination chemotherapy. Thalidomide would not be typically used for NHL, although it is a treatment for multiple myeloma.

Which treatment options will the nurse anticipate when caring for a patient with a newly diagnosed stage I indolent (low-grade) non-Hodgkin's lymphoma (NHL)? Select all that apply. a. Rituximab b. Thalidomide c. External beam irradiation d. Single-agent chemotherapy e. Combination chemotherapy

c. Doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy The standard treatment for favorable early-stage Hodgkin's lymphoma is combination chemotherapy with an ABVD chemotherapy regimen. Rituximab is a monoclonal antibody used in some leukemias and in non-Hodgkin's lymphoma. Radiation is not a first-line treatment for Hodgkin's lymphoma but may be added to chemotherapy for higher stage disease or resistance to the initial chemotherapy. ESHAP combination chemotherapy is used for aggressive non-Hodgkin's lymphoma.

Which treatment regimen will the nurse expect to administer for a patient with newly diagnosed stage IIA Hodgkin's lymphoma? a. Single agent therapy with rituximab b. Radiation therapy to the involved site c. Doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy d. Etoposide, methylprednisolone (Solu-Medrol), high dose cytarabine (Ara-C), and cisplatin (Platinol) (ESHAP) chemotherapy

d. Desmopressin acetate (DDAVP) DDAVP is beneficial for a patient with mild hemophilia A and certain subtypes of von Willebrand disease. It is a synthetic analog of vasopressin and may be used to stimulate an increase in factor VIII and von Willebrand factor (vWF). Splenectomy is indicated only if the patient does not respond to drug therapy. IV immunoglobulin is used in a patient who is unresponsive to corticosteroids or splenectomy. Romiplostim therapy is used in a patient with chronic immune thrombocytopenic purpura (ITP) who had an insufficient response to the other treatments or who has a contraindication to splenectomy.

Which treatment would the nurse anticipate incorporating into the plan of care for a patient with mild hemophilia A? a. Splenectomy b. IV immunoglobulin c. Romiplostim therapy d. Desmopressin acetate (DDAVP)

c. Cushing syndrome The image illustrates a patient with symptoms of Cushing syndrome, which is characterized by overexposure to corticosteroid hormones. Addison's disease is a disorder of adrenocortical insufficiency. Conn syndrome is a disorder of hyperaldosteronism. Pheochromocytoma is a tumor of the adrenal medulla.

Which type of adrenal disorder is illustrated? a. Conn syndrome b. Addison's disease c. Cushing syndrome d. Pheochromocytoma

d. Fresh frozen plasma The liquid portion of whole blood is separated from cells and frozen to obtain fresh frozen plasma. It is rich in clotting factors. Therefore the nurse administers frozen plasma to the patient. Albumin is prepared from plasma, but it is not rich in clotting factors. Platelets and frozen RBCs will not help to provide clotting factors to the patient.

Which type of blood product would the nurse anticipate incorporating into the plan of care for a patient with disseminated intravascular coagulation (DIC)? a. Albumin b. Platelets c. Frozen red blood cells (RBCs) d. Fresh frozen plasma

b. Christmas factor deficiency Christmas factor, or factor IX, is a clotting protein, and its deficiency causes hemophilia B; this leads to prolonged or spontaneous bleeding. Iron deficiency causes anemia. Anti-hemophilic factor, or factor VIII deficiency, causes hemophilia A. Von Willebrand coagulation protein deficiency causes von Willebrand disease.

Which type of deficiency causes hemophilia B in a patient? a. Iron deficiency b. Christmas factor deficiency c. Anti-hemophilic factor deficiency d. Von Willebrand coagulation protein deficiency

b. Blood draw for renal function and electrolytes Since acute kidney injury (acute renal failure) is a complication of tumor lysis syndrome, the nurse will anticipate a blood draw for blood urea nitrogen and creatinine levels to check renal function and electrolytes levels to assess for possible hyperkalemia. An abdominal ultrasound might be used for a patient with problems such as abdominal distension but would not be helpful in evaluating or treating tumor lysis syndrome. CT scans are used to assess for spread of lymphoma and assist in staging but would not be helpful in tumor lysis syndrome. Bone marrow biopsy is a useful tool for diagnosis of many hematologic disorders but is not helpful for diagnosis or guiding treatment of tumor lysis syndrome.

Which type of diagnostic test will the nurse anticipate when a patient is admitted with suspected tumor lysis syndrome? a. Abdominal ultrasound to assess tumor size b. Blood draw for renal function and electrolytes c. CT for tumor staging d. Bone marrow biopsy to assess for abnormal cells

a. Hepatitis A When an individual is infected with the hepatitis A virus, the body produces the hepatitis A antibody gM. Hepatitis B (HB) is diagnosed by performing anti-HBc IgG and anti-HBe tests. Anti-HCV, HCV genotyping, and HCV RNA quantification are performed to rule out hepatitis C. Hepatitis D is confirmed by performing anti-HDV and HDV antigen tests.

Which type of hepatitis may be diagnosed with an immunoglobulin M (IgM) antibody test? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D

b. Acute myelogenous leukemia (AML) AML accounts for 15% to 20% of acute leukemia in children and 80% in adults. ALL is most frequently seen in children, with a mean age of 15 years at diagnosis. CLL is a chronic leukemia seen mostly in older adults but is not an acute leukemia. CML is a chronic, rather than acute, leukemia seen mostly in older adults.

Which type of leukemia accounts for the majority of acute leukemia in adults? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)

a. Acute lymphocytic leukemia (ALL) ALL is characterized by the presence of an excessive number of immature small lymphocytes in the bone marrow. AML is characterized by an increase in the number of myeloblasts. CLL is characterized by the accumulation of small, mature-appearing lymphocytes. CML occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.

Which type of leukemia is characterized by the proliferation of immature small lymphocytes in the bone marrow? a. Acute lymphocytic leukemia (ALL) b. Acute myelogenous leukemia (AML) c. Chronic lymphocytic leukemia (CLL) d. Chronic myelogenous leukemia (CML)

b. Antibiotic therapy Antibiotics are included in the treatment for Helicobacter pylori gastric lymphoma because the bacteria contribute to the development of lymphoma. Phototherapy would be used to treat more superficial lymphomas such as cutaneous T-lymphoma. Radiation therapy might be used to treat resistant or refractory lymphoma but is not an initial treatment for Helicobacter pylori gastric lymphoma. Topical chemotherapy would be used for superficial lesions such as in cutaneous T-cell lymphoma.

Which type of therapy will the nurse anticipate administering to a patient who has newly diagnosed Helicobacter pylori gastric lymphoma? a. Phototherapy b. Antibiotic therapy c. Radiation therapy d. Topical chemotherapy

a. Vitamin A c. Vitamin D d. Vitamin E e. Vitamin K Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat soluble and thus would need to be supplemented in a patient with biliary obstruction. Vitamin B is water soluble and would not be recommended for a patient with biliary obstruction.

Which vitamin supplements would the nurse anticipate administering for a patient with a biliary obstruction? Select all that apply. a. Vitamin A b. Vitamin B c. Vitamin D d. Vitamin E e. Vitamin K

d. "It prevents staining of the teeth." An undiluted iron preparation causes staining of the teeth if consumed without using a straw. Such preparations should therefore be taken using a straw. Compared to drinking undiluted liquid iron without a straw, consuming it with a straw does not boost iron absorption, reduce iron absorption, or reduce allergic reactions.

While taking undiluted liquid iron that was prescribed, a patient asks the nurse why it must be drunk through a straw. Which response by the nurse is appropriate? a. "It reduces iron absorption." b. "It increases iron absorption." c. "It reduces allergic reactions." d. "It prevents staining of the teeth."