chronic and pall exam 1 prep us

A client is scheduled for a CABG procedure. What information should the nurse provide to the client? "The CABG procedure will help increase intestinal motility and prevent constipation." "A coronary artery bypass graft will benefit your heart." "The CABG procedure will help identify nutritional needs." "A complete ablation of the biliary growth will decrease liver inflammation."

"A coronary artery bypass graft will benefit your heart."

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "Draining of the cysts and antibiotic therapy will cure your disease." "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys." "Genetic testing will determine the best treatment for your condition."

"As the disease progresses, you will most likely require renal replacement therapy." There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

A young female client smokes two packs of cigarettes and drinks a six-pack of beer each day. The nurse is attempting to teach the client about smoking cessation and decreasing alcohol intake. The client states, "My grandmother lived to be in her 90s, and she smoked and drank. I come from good genes." What is the most appropriate statement the nurse can make in response? "Smoking cigarettes and drinking alcohol will kill you." "Certain illnesses can be traced to common risk factors and can be prevented." "Yes, you do come from good genes." "It is good that you know your body and your family history so well."

"Certain illnesses can be traced to common risk factors and can be prevented."

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Even a perfect match does not guarantee organ success." "Let's wait until after the surgery to discuss your treatment plan." "The doctor may decide to delay the use of immunosuppressant drugs." "Immunosuppressive drugs guarantee organ success."

"Even a perfect match does not guarantee organ success." Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is appropriate to warm the dialysate in a microwave." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity." "It is important to use strict aseptic technique."

"It is appropriate to warm the dialysate in a microwave." The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? "It will hasten the death of the patient." "It will prolong life in a dignified manner." "It will enable the patient to remain home if that is what is desired." "It will use artificial means of life support if the patient requests it."

"It will enable the patient to remain home if that is what is desired." The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life. The patient and family make up the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.

A client who will be undergoing a Holter monitor examination would be given which instruction? "You will need to have an intravenous injection prior to the start of the test." "Wear clothing that you can exercise in during the test." "Keep a diary of your activities and symptoms throughout the examination." "Lay very still during the procedure for an accurate reading."

"Keep a diary of your activities and symptoms throughout the examination."

A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? "Liberally apply alcohol to the areas of your skin where you itch the most." "When you shower, use really warm water and an antibacterial soap." "Keep your showers brief, patting your skin dry after showering." "Try washing clothes with a strong detergent to ensure that all impurities are gone."

"Keep your showers brief, patting your skin dry after showering." The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash clothes and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue.

A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client? "Let's take this one day at a time; remember you have your daughter's dance recital next week." "You should seek a second medical opinion about your diagnosis." "I know another client with the same diagnosis who has been in remission for 10 years." "I believe that you will fight hard to beat this and see your babies grow up."

"Let's take this one day at a time; remember you have your daughter's dance recital next week." Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Although he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Reponses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.

A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give? "I am not at liberty to disclose that information." "Why do you think that?" "Did someone tell you that you are dying?" "Tell me more about what's on your mind."

"Tell me more about what's on your mind." In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind"). The nurse then needs to listen intently, ask additional questions for clarification, and provide reassurance only when it is realistic.

The nurse is caring for a patient who had a stroke and has right-sided hemiparesis. The patient is receiving physical therapy that will continue when discharged through home health care services. After what minimum period of time could this patient's medical condition be termed chronic? 6 months 16 weeks 8 weeks 3 months

3 months Chronic diseases or conditions are often defined as medical conditions or health problems with associated symptoms or disabilities that require long-term management. Some definitions use a duration of 3 months or longer, whereas others use a year or longer to indicate chronic disease. Definitions of chronic disease or chronic illness share the characteristics of being irreversible, having a prolonged course, and unlikely to resolve spontaneously (Lubkin & Larsen, 2013).

As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which teaching point best captures a component of cardiac function? "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." "Efficient heart function requires that the ventricles not retain any blood at the end of the cardiac cycle. "Recall that the heart sounds that we listen to as part of our assessments are the sounds of the myocardium contracting." "Aortic pressure will exceed ventricular pressure during systole."

"The diastolic phase is characterized by relaxation of ventricles and their filling with blood." Diastole is associated with ventricular filling and relaxation. Cardiac output is not 100% (or near to it) with each cardiac cycle, and heart sounds are associated with valve closing. Ventricular pressure exceeds that of the aorta during systole.

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes. Is he in pain?" Which response by the nurse would be most appropriate? "His moaning does indicate pain, so we'll increase his pain medication." "He has secretions that are collecting at the back of the throat." "He is getting less oxygen to the brain, so the moaning means he is dreaming." "The moaning you hear is from air moving over very relaxed vocal cords."

"The moaning you hear is from air moving over very relaxed vocal cords." As a client approaches death, certain signs appear. The family is reporting irregular breathing with periods of apnea. The moaning that they hear reflects the sound of air passing over very relaxed vocal cords. It does not signify pain or distress. Therefore, no additional pain medication would be needed. Secretions collecting at the back of the throat are noted by a rattling or gurgling sound. Decreased oxygen to the brain would lead to confusion, which may be reported by the client as strange dreams or visions.

Upon hearing a blood pressure reading of 146/96 mm Hg, a 58-year-old client asks whether medication will be necessary. Which would be the best response by the nurse? "We will need to reevaluate the blood pressure because your age places you at a high risk for hypertension." "You have no need to worry. Your blood pressure is probably elevated because you are in the physician's office." "It's fortunate that you came into the clinic today and this was caught this during your routine examination." "You will need to have your blood pressure reassessed before a diagnosis can be made."

"You will need to have your blood pressure reassessed before a diagnosis can be made." Hypertension is confirmed by at least two measurements greater than 129/80 mm Hg and taken on two separate occasions. The nurse should provide factual information to the client, not provide false hope.

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which statement by the physician best captures an aspect of these differences? "You'll find that, in pediatric clients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." "Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate." "Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young clients." "Fever is a sign of heart failure in children that you are unlikely to see in older adults."

"You'll find that, in pediatric clients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." The pulmonary edema that accompanies heart failure is more often interstitial rather than alveolar in children. Jugular venous distention is difficult to gauge in children. Low blood pressure and fever are not noted signs of heart failure in children.

A client is prescribed a 12.5-mg dose of metoprolol for the treatment of high blood pressure. The nurse should administer how many 25-mg tablets? 2 1 0.5 1.25

0.5

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 2,000 mL of fluid 500 mL of fluid 1,000 mL of fluid 1,500 mL of fluid

1,500 mL of fluid A 1-kg weight gain is equal to 1,000 mL of retained fluid.

Based on the most common concern of a dying patient, the hospice nurse should: Turn the patient every 2 hours to prevent decubitus ulcers. Offer supplemental fluids to prevent dehydration. Position the patient to prevent difficulties with breathing. Administer pain medication on a schedule that prevents pain from intensifying.

Administer pain medication on a schedule that prevents pain from intensifying. Pain management is the most common concern for the dying patient. Medication should be given on a PRN schedule that keeps the patient comfortable.

The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.

4000 mL

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6 tablets

Which of the following is an appropriate intervention for the client with pulmonary edema? Administer the prescribed sedative to decrease anxiety. Use chest percussion. Position the client supine. Suction as needed to clear the lungs.

Administer the prescribed sedative to decrease anxiety. Suctioning will not clear the lungs or ease breathing if the client has pulmonary edema. In this situation, the physician may prescribe a sedative to relieve the anxiety created by the feeling of suffocation.

Which client is at greatest risk for orthostatic hypotension? A 42-year-old male client with history of pulmonary embolism A 66-year-old postoperative client on bed rest A 70-year-old female client who has taken the same antihypertensive medication for 10 years A 20-year-old pregnant client at 36 weeks' gestation

A 66-year-old postoperative client on bed rest Postoperative clients who have been immobile are at greatest risk for developing orthostatic hypotension. The 70-year-old female may also be at some risk: age is a risk factor, as is administration of some antihypertensive medications.

A number of clients have presented to the emergency department in the last 32 hours with reports that are preliminarily indicative of myocardial infarction. Which client is least likely to have an ST-segment myocardial infarction (STEMI)? A 70-year-old woman who is reporting shortness of breath and vague chest discomfort A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 30-59 mL/min/1.73 m2 A GFR of 90 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2

A GFR of 30-59 mL/min/1.73 m2 Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2

A patient with amyotrophic lateral sclerosis (ALS) wishes to use his Medicare Hospice Benefit in an effort to maximize his quality of life prior to death. What criterion will determine whether the patient qualifies for this benefit? A demonstrated lack of a support system Exhaustion of all reasonable treatment options A life expectancy of less than 6 months Copayment by a health insurance provider

A life expectancy of less than 6 months According to Medicare, the patient who wishes to use his or her Medicare Hospice Benefit must be certified by a health care provider as terminally ill, with a life expectancy of 6 months or less if the disease follows its natural course. Exhaustion of treatment options, copayment, and a lack of social support are not criteria used to determine qualification.

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of an insulin drip Administration of sodium polystyrene sulfonate [Kayexalate]) Administration of sodium bicarbonate Administration of a loop diuretic

Administration of sodium polystyrene sulfonate [Kayexalate]) The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

A nurse is caring for a terminally ill client who is receiving chemotherapy and radiation for an aggressive lung cancer. The treatment success is limited in shrinking the tumor, and the treatments are making the client very ill. The client states, "I feel that I would like to stop treatments. I would like to enjoy the time that I have remaining with my family." Which emotional reaction does the nurse recognize that the client is experiencing? Denial Bargaining Acceptance Anger

Acceptance In the final stage, dying clients accept their fate and makes peace spiritually and with those to whom they are close. Clients begin to detach themselves socially and wish to be with only a small group of close friends and family. The other options are stages that occur earlier in the process.

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin and exenatide and reports adhering to a diet. The glycohemoglobin is 5.9%. According to the stable phase of the Trajectory Model of Chronic Illness, how should the nurse respond? Responds, "There are some adjustments to your medications that need to be made" Advises the client that changes must be made to the diet Acknowledges that the client is performing satisfactorily States, "The glycohemoglobin is too high"

Acknowledges that the client is performing satisfactorily In the stable phase of the Trajectory Model of Chronic Illness, the nurse reinforces positive behaviors. The glycohemoglobin is at a level of good control for a client with diabetes. No adjustments need to be made to the diet or the medications.

An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse Acknowledges the client's achievement when she walks to the bedside commode with her walker Assesses postural blood pressures Discontinues the intravenous needle and changes the surgical dressing prior to discharge from the hospital Teaches the client about osteoporosis

Acknowledges the client's achievement when she walks to the bedside commode with her walker In the comeback phase of the Trajectory Model of Chronic Illness, the nurse provides positive reinforcement for goals identified and accomplished by the client. This would be acknowledging the client's achievement when she ambulates to the bedside commode with her walker.

The client who has the chronic condition of diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. What phase of the Trajectory Model of Chronic Illness does the nurse assess this client is in? Acute Pretrajectory Stable Comeback

Acute In the acute phase of the Trajectory Model of Chronic Illness the client has severe and unrelieved symptoms or complications that necessitate hospitalization. The client's blood glucose level is high enough that hospitalization may be required. The pretrajectory phase is one in which lifestyle behaviors place a client at risk for a chronic condition. The stable phase is characterized by symptoms of illness being under control. The comeback phase is one in which there is a gradual recovery to an acceptable way of life.

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Acute glomerulonephritis Nephrotic syndrome Acute renal failure Chronic renal failure

Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care? Advice for the family to have fruit juices readily available at the client's bedside. Encouragement of the family to serve the client meat, especially beef. Arrangements for the client to eat meals while others are out of the home. Suggestions that the family offer the client foods that are hot.

Advice for the family to have fruit juices readily available at the client's bedside. To promote nutrition in the terminally ill, the nurse would encourage the family to have fruit juices and milkshakes readily available at the bedside so that the client can access them frequently. Cool foods may be better tolerated than hot foods. Cheese, eggs, peanut butter, mild fish, chicken, and turkey are often better choices than meat such as beef that may taste bitter and unpleasant. Meals should be scheduled when family members are present to provide company and stimulation.

A nurse practitioner would be applying the pre-trajectory model of chronic illness when she: Encouraged a post-fracture patient to continue physical therapy. Suggested home health care to a stroke victim. Explained the significance of a serum glucose level of 160 mg/dL. Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing.

Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing. The pre-trajectory phase involves the prevention of a chronic illness. For example, the focus of nursing care would be to refer the patient for genetic testing and counseling, if indicated, and provide education about prevention of modifiable risk factors and behaviors.

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need for which accomplishments? Select all that apply. Alleviate and manage symptoms Ignore threats to identity Validate family functioning Validate individual self-worth Return to a better state of health than prior

Alleviate and manage symptoms Validate individual self-worth Validate family functioning

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

Altered mental status

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body? Increases procoagulant factors Alters vitamin K, reducing its ability to participate in the coagulation of the blood Increases vitamin K-dependent factors in the liver Increases prothrombin

Alters vitamin K, reducing its ability to participate in the coagulation of the blood

Which act mandates that people with disabilities have access to job opportunities and to the community? Title II Americans with Disabilities Act of 1990 Title XVI Rehabilitation Act of 1973

Americans with Disabilities Act of 1990

A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? Anemia Pericarditis Hyperkalemia Acidosis

Anemia Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.

A client with a terminal illness has feelings of rage toward the nurse. According to Kubler-Ross, the client is in which stage of dying? Denial Anger Depression Bargaining

Anger Anger includes feelings of rage or resentment. Denial includes feelings of isolation. Bargaining occurs when a client and/or family pleads for more time to reach an important goal. Depression includes sadness, grief, and mourning for an impending loss.

A client has a tentative diagnosis of lung cancer following computed tomography (CT) scanning. He is scheduled for a fiberoptic bronchoscopy with biopsy. In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse Administers the preoperative medication for the bronchoscopy Obtains the signature of the client on the consent form Answers the client's questions about the bronchoscopy procedure Provides postprocedure care following the bronchoscopy

Answers the client's questions about the bronchoscopy procedure In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse provides explanations of diagnostic tests and procedures, such as the bronchoscopy with biopsy. The nurse will reinforce information and explanations provided by the physician.

The nurse is justified in assessing for sexual dysfunction among male clients who are receiving which of the following? Bronchodilators Antihypertensive medication Non-steroidal anti-inflammatory drugs (NSAIDs) Antibiotics

Antihypertensive medication Antihypertensives are among the drugs implicated in sexual dysfunction. Antihypertensives can decrease forceful blood flow to the penis, making it difficult to achieve an erection. Antibiotics, bronchodilators, and NSAIDs do not typically have this effect.

The nurse is talking to an older adult client who performs home blood pressure monitoring (HBPM) and finds that recently her BP measurements have consistently been low. Which factors may contribute to causing this client's BP to be falsely decreased? Select all that apply. Applying a cuff that is too narrow Using cracked or kinked tubing Assessing the BP immediately after exercise Applying too wide a cuff Releasing the valve rapidly

Applying too wide a cuff Releasing the valve rapidly Using cracked or kinked tubing

The nurse is caring for a client who has a compromised cardiopulmonary system and needs to assess the client's tissue oxygenation. The nurse would use which appropriate method to assess this client's oxygenation? Hematocrit values Pulmonary function Arterial blood gas Hemoglobin levels

Arterial blood gas

A nurse places electrodes on a collapsed individual who was visiting a hospitalized family member. The monitor exhibits the following. Which interventions would the nurse do first? Administer amiodarone I.V. as prescribed. Place the client on oxygen. Confirm the rhythm with a 12-lead ECG. Assess the client's airway, breathing, and circulation.

Assess the client's airway, breathing, and circulation.

A client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action? Assess the client's blood pressure Perform a Mini Mental Status Examination (MMSE) Call an emergency code Assess the client's jugular venous pressure

Assess the client's blood pressure Combining phenelzine with beer can precipitate a hypertensive crisis. There is no immediate indication that an emergency code is needed. The client's jugular venous pressure is less likely to be affected and is not a priority for assessment. Performing the MMSE is not a short-term priority.

Paroxysmal supraventricular tachycardia arises from which form of reentry? Orthodromic True Atrioventricular (AV) nodal Bundle of His nodal

Atrioventricular (AV) nodal Paroxysmal supraventricular tachycardia refers to tachydysrhythmias that originate above the bifurcation of the bundle of His and have a sudden onset and termination. It may be the result of AV nodal reentry. The other options are not responsible for paroxysmal supraventricular tachycardia.

A nurse is assigned to work with a client who has a disability. The nurse believes that all people with disabilities have a poor quality of life and are dependent and nonproductive. What type of barrier will this client experience? Attitudinal barrier Structural barrier Barrier to health care Transportation barrier

Attitudinal barrier Attitudinal barriers are barriers in which bias, mistaken beliefs, and prejudices impose limitations for people with disabilities. This client experienced no barrier to health care, no structural barrier, and no transportation barrier as currently defined.

The acute care nurse is assessing a newly admitted client's abdomen. Which finding would indicate the need to contact the health care provider? Auscultation of bowel sounds every 30 seconds Auscultation of a bruit Auscultation of gurgles and clicks Umbilicus centrally located

Auscultation of a bruit A bruit may be heard in the presence of stenosis (narrowing) or occlusion of an artery. Bruits may also be caused by abnormal dilation of a vessel. The other findings are normal.

Which intervention should a nurse perform during the grieving period when caring for a dying client? Avoiding criticizing or giving advice Spending time with the client Allowing a period of privacy Providing palliative care

Avoiding criticizing or giving advice The nurse should listen in a nonjudgmental manner and should avoid criticizing or giving advice during the grieving period when caring for dying clients. Allowing a period of privacy is necessary to help family members cope with the death of a client and is not necessary during the grieving period. Spending time with the client and providing palliative care are not the required nursing interventions during the grieving period. Palliative care is provided to a dying client when the client is unable to live independently.

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? Glomerular filtration rate (GFR) of 100 mL/min. Serum creatinine of 1.2 mg/dL. BUN of 18 mg/dL. Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.

Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. The normal BUN:Cr ratio is less than 15. Prerenal azotemia is caused by hypoperfusion of the kidneys due to a nonrenal cause. Over time, higher than normal blood levels of urea or other nitrogen-containing compounds will develop.

Which clinical manifestations would the nurse identify as indications of increased blood glucose levels? Select all that apply. Hypertension Blurred vision Skin infections Thirst Fatigue

Blurred vision Thirst Fatigue Skin infections

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Uses moisturizing creams Brief, hot daily showers Pats skin dry after bathing Keeps nails trimmed short

Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

The nurse is assigned to care for the client with primary ciliary dyskinesia. What effect does this syndrome have on the body that the nurse should be aware of? Select all that apply. A reversal of the thorax and abdominal organs Bronchiolitis Sinus aplasia Hearing impairment Peripheral neuropathy

Bronchiolitis Sinus aplasia A reversal of the thorax and abdominal organs

The instructor provides corrective information to the nursing student when the student refers to the client as the Woman who has diabetes COPDer in 216 Man with an MI Patient who is disabled

COPDer in 216 "People-first" language means referring to the person first. Examples include patient who is disabled, man with an MI, and woman who has diabetes. Using "COPDer in 216" conveys that the illness or disability is of greater importance than the person.

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? Calcium Phosphorus Sodium Magnesium

Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

The nurse is caring for a client who is interested in learning about hospice care. Which of the eligibility criteria would the nurse stress? Serious, progressive illness Physician-certified illness Choice of palliative care over cure focused Limited life expectancy

Choice of palliative care over cure focused An important focus of hospice care is that care is palliative in nature. No further aggressive treatment to find a cure for the illness is administered. The client must accept this philosophy of care. The other options are factual and agreed on.

The nurse is caring for a client with diabetes. Which of the following is a characteristic of chronic illness? Chronic illness affects the entire family. Managing chronic conditions must be an individual process. One chronic disease never develops into another chronic condition. Chronic conditions only involve one aspect of a person's life.

Chronic illness affects the entire family. Chronic illness affects the entire family to the extent that family life can be dramatically altered. Managing chronic conditions must be a collaborative process. One chronic disease can lead to the development of other chronic conditions. Chronic conditions usually involve many different phases over the course of a person's lifetime.

Which statement is a misconception about chronic disease? Chronic illnesses cannot be prevented. The major cause of chronic disease is known. Chronic illness typically does not result in sudden death. Almost half of chronic disease-related deaths occur prematurely in people <70 years of age.

Chronic illnesses cannot be prevented. A misconception regarding chronic disease is that chronic illnesses cannot be prevented. Almost half of chronic disease-related deaths occur prematurely in people younger than 70 years of age. Chronic illness typically does not result in sudden death. The major cause of chronic disease is known.

The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium? Citrus fruits Salad oils Cooked white rice Butter

Citrus fruits Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.

A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client's symptoms? Client's goals Invasiveness of the treatment Length of required treatment Physician's orders

Client's goals When managing the symptoms of a client with a terminal illness, the client's goals take precedence over the clinician's goals to relieve all symptoms at all costs. Although the length and invasiveness of the treatment may influence decision making, ultimately it is the client's goals that determine what will be done.

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services? Lack of Medicare/Medicaid funding for hospice Difficulty obtaining Medicare certification for hospice services Lack of fully credentialed and trained hospice nurses Clients and families view hospice care as giving up

Clients and families view hospice care as giving up Clients often equate hospice with giving up and are reluctant to accept hospice care. Lack of fully credentialed and trained hospice nurses is not a barrier to hospice care. Lack of Medicare funding and lack of certification for hospice service providers have not been documented as barriers to access of hospice services.

Glaser and Strauss (1965) identified four "awareness contexts." Which awareness context occurs when the client is unaware of their terminal state, whereas others are aware? Closed awareness Mutual pretense awareness Suspected awareness Open awareness

Closed awareness Closed awareness occurs when the client is unaware of their terminal state, whereas others are aware. Suspected awareness occurs when the client suspects what others know and attempts to find out details about the condition. Open awareness occurs when the client, the family, and the health care professionals are aware that the client is dying and openly acknowledge that reality. Mutual pretense awareness occurs then the client, the family, and the health care professionals are aware that the client is dying but all pretend otherwise.

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Hypotension Cola-colored urine Peripheral neuropathy Hyperalbuminemia

Cola-colored urine Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

The nurse is working with a client who has difficulty controlling blood sugar. The client is classified as overweight. The client does not adhere to a low-calorie diet and forgets to take medications and check blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, what action will the take first? Collaborates with the client to establish an agreed-upon goal Informs the client about what goal the nurse wants the client to achieve Sets the long-term goal as "the client's glycohemoglobin will be 6.9% in 3 months" Plans the short-term goal as "the client's blood sugar each AM will be less than 110 mg/dL"

Collaborates with the client to establish an agreed-upon goal When establishing a goal, the nurse should collaborate with the client. The nurse does not dictate to the client what the goal will be. Goals must be consistent with the abilities and motivation of the client. The long-term and short-term goals may not be realistic for this client.

Which phase of the Trajectory Model does the nurse recognize is present when the patient is in remission, after an exacerbation of illness? Crisis Downward course Comeback Acute

Comeback

A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient? Compatible blood and tissue types Blood relationship Sex and size Need

Compatible blood and tissue types The donor and recipient must have compatible blood and tissue types. They should be fairly close in size and age, but these factors aren't as important as compatible blood and tissue types. When a living donor is considered, it's preferable to have a blood relative donate the organ. Need is important but it can't be the critical factor if a compatible donor isn't available.

A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply. Comfort the client by saying it will all be over soon. Recommend that the client consider physician-assisted suicide. Control the client's pain with prescribed medication. Encourage the client to explain his or her wishes. Advise the client's health care provider of the client's condition.

Control the client's pain with prescribed medication. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes. This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation. Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse's role to suggest physician-assisted suicide voluntarily, however.

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? Obstruction of urine flow from the kidneys Blood clot formed in the kidneys interfered with the flow Decrease in the blood flow through the kidneys Structural damage occurred in the nephrons of the kidneys

Decrease in the blood flow through the kidneys Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?

Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

An 80-year-old is brought to the clinic by the client's spouse. The client has a history of peripheral vascular disease and type 2 diabetes. The spouse states that the client hasn't seemed to be normal for the preceding few days, noting that the client has been lethargic and mildly confused at times and has been incontinent of urine. The spouse reports that the client's blood glucose levels have been elevated. The nurse considers which as the most likely explanation for the client's change in mental status? Delirium related to underlying medical problem Depression related to declining health Dementia related to advancing age Transient ischemic attacks related to vascular disease and diabetes

Delirium related to underlying medical problem

What barrier to end-of-life care does a dying client demonstrate with the statement, "I don't need hospice. Hospice is for people who are dying." Anger Acceptance Denial Bargaining

Denial Patient denial about the seriousness of terminal illness has been cited as a barrier to discussions about end-of-life treatment options. Denial includes feelings of isolation. Bargaining occurs when a client and/or family pleads for more time to reach an important goal. Anger includes feelings of rage or resentment. Acceptance occurs when the client and/or family are neither angry nor depressed.

Which is the initial stage of grief, according to Kübler-Ross? Depression Anger Bargaining Denial

Denial The stages of grief include denial, anger, bargaining, depression, and acceptance. Anger is the second stage of the process. Bargaining is the third stage of the process. Depression is the fourth stage of the process.

This type of disability represents one that occurs any time from birth to 22 years and results in impairment of physical or mental health, cognition, speech, language, or self-care. Developmental Acquired Age-related Acute nontraumatic

Developmental

Which chronic illness directly related to an unhealthy lifestyle does the nurse understand is increasing rapidly? Breast cancer Diabetes mellitus Colorectal cancer Emphysema

Diabetes mellitus The increasing prevalence of obesity has increased the incidence of heart disease, strokes, diabetes, and hypertension. Obesity also affects one's self-esteem, achievement, and emotional state (Galuska & Dietz, 2010).

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? Impaired immunologic response Electrolyte imbalances Diminished erythropoietin production Azotemia

Diminished erythropoietin production Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic renal failure but not indicated with anemia.

A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as Stable Crisis Downward Acute

Downward The downward phase of the Trajectory Model of Chronic Illness is characterized by a worsening of the client's condition with alterations in everyday activities. The stable phase is one in which the client's symptoms are under control. The acute phase is characterized as severe and unrelieved symptoms necessitating hospitalization, bedrest, or interruption of the client's usual activities to bring the disease under control. The crisis phase is one in which the situation is critical or life-threatening and requires emergency care.

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using? Durable power of attorney for health care Living will declaration End-of-life treatment directive Medical directive by proxy

Durable power of attorney for health care A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.

A client arrives at the emergency department with chest and stomach pain and a report of black, tarry stools for several months. Which diagnostic testing would the nurse anticipate? cardiac monitoring, oxygen, creatine kinase, and lactate dehydrogenase (LD) levels ECG (electrocardiogram), complete blood count, testing for occult blood, and comprehensive serum metabolic panel prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and fibrin split product values EEG (electroencephalogram), alkaline phosphatase and aspartate aminotransferase levels, and basic serum metabolic panel

ECG (electrocardiogram), complete blood count, testing for occult blood, and comprehensive serum metabolic panel

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause? Shorter lifespans Lowered stress and increased physical activity lifestyles Early detection and treatment of diseases An increased mortality rate from infectious diseases

Early detection and treatment of diseases

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations? Encourage the family members to express their feelings and listen to them in their frank communication. Encourage the patient's family members to spend time with the patient. Be a silent observer and allow the patient to communicate with the family members. Encourage conversations on the impending death of the patient.

Encourage the family members to express their feelings and listen to them in their frank communication. Family members usually find it difficult to communicate frankly with a dying person. By encouraging family members to express their feelings and listening to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying patient. It is not advisable for the nurse to encourage conversations on the impending death of the patient. Being a silent observer or encouraging the family members to spend time with the dying patient may not help the family members to express their feelings.

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? Keep the drainage catheter below the level of insertion. Monitor temperature every 4 hours. Administer isotonic fluid therapy as ordered. Encourage use of incentive spirometer every 2 hours.

Encourage use of incentive spirometer every 2 hours. To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition. End-stage renal disease Coronary artery disease Type 2 diabetes mellitus Carcinoma-in-situ

End-stage renal disease Certain illnesses require advanced technology for survival, or intensive care for periods of weeks or months, as in end-stage renal disease (ESRD). People with this condition are chronically critical and progressively ill. Some chronic illnesses have little effect on quality of life, but others, like ESRD, have a considerable effect because it can result in a chronic progressive deterioration.

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following? Participate in a support group to learn clients' feeling on care. Explore own feelings on mortality and death and dying. Use evidence-based practice in daily care regimen. A workshop on caring for the dying client

Explore own feelings on mortality and death and dying. To care for others in the dying process, the nurse must explore his or her own feelings about mortality and death and dying. Understanding self provides a perspective to cope with and then support clients and families experiencing pain and grief. The other options are helpful in determining appropriate nursing care but not the first step.

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents? FHR fluctuation range is undetectable. FHR fluctuates over 25 beats per minute. FHR fluctuates less than 5 beats per minute. FHR fluctuates from 6 to 25 beats per minute.

FHR fluctuates from 6 to 25 beats per minute.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Absence of pain Fever Weight loss Diuresis

Fever Fever is an indicator of infection or transplant rejection.

A client, aged 87, undergoes continuous ambulatory peritoneal dialysis (CAPD) for acute renal failure (ARF). Which task would be most important for the nurse to do? Note a color change in the client's eyes, teeth, and nails. Monitor the client for hypoglycemia and hyperglycemia. Ensure a diet rich in proteins and potassium. Frequently monitor the client's progress.

Frequently monitor the client's progress. Older clients who are not candidates for kidney transplants may receive CAPD. More frequent monitoring of the client's progress is required when this technique is used. The recommendations for protein and potassium in the diet are highly variable based on the client's condition. Change in the color of client's teeth, eyes, and nails need not be monitored, nor does the client need to be monitored for hypoglycemia and hyperglycemia.

Which of the following nursing interventions will a nurse perform to transfer heat and improve circulation in a dying client? Administer warm intravenous fluids. Administer intramuscular injections. Gently massage the arms and legs. Change the position frequently.

Gently massage the arms and legs. A nurse should gently massage the client's arms and legs to transfer heat and improve circulation in a dying client. Changing the position frequently helps protect the client's skin from breakdown. Administering warm intravenous fluids and intramuscular injections will not help transfer heat and improve circulation in a dying client.

Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Glomerulonephritis Hypovolemia Dysrhythmia Ureteral calculus

Glomerulonephritis Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? Seizures Tremors Asterixis Gray-bronze skin color

Gray-bronze skin color Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.

Which term is used to describe the personal feelings that accompany an anticipated or actual loss? Spirituality Bereavement Grief Mourning

Grief Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.

A client who is legally blind had orthopedic surgery 3 days ago and wants to urinate. She is using a walker for ambulation. It would be best for the nurse to Obtain assistance of another staff member and not have the client use the walker. Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode. Place a bedside commode next to the bed. Assist the client in using a bedpan.

Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode. When the nurse offers seating to a client with low vision or blindness, the nurse should place the client's hand on the arm of the chair. This helps to guide the client in sitting. Though placing the bedside commode next to the bed is a good idea, it is not the best choice. The nurse will encourage the client to use the bedside commode, not the bedpan, for better emptying of the urinary bladder.

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color? Hemangioma Xanthelasma Milia Nevi

Hemangioma

To assess circulating oxygen concentration, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which diagnostic test? Serum iron concentration Arterial blood gases Hematocrit Hemoglobin

Hemoglobin

Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability. Norepinephrine Prostaglandins Histamine Serotonin

Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Norepinephrine is a powerful vasoconstrictor. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.

The primary care provider has prescribed estrogen replacement therapy (ERT) for a menopausal woman who has been diagnosed with pelvic organ prolapse (POP). The client asks the nurse why she needs to be on hormones. Which would be the nurse's best response? Hormone replacement will increase the blood perfusion and decrease the elasticity of the vaginal wall. Hormone replacement will decrease blood perfusion and increase the elasticity of the vaginal wall. Hormone replacement will decrease blood perfusion and the elasticity of the vaginal wall. Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall.

Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall.

Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement? Behavioral changes Hypertension Decreased cognitive ability Chest pain

Hypertension

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Abdominal distention owing to reflex cessation of intestinal peristalsis Hypovolemic shock caused by hemorrhage Paralytic ileus caused by manipulation of the colon during surgery Pneumonia caused by shallow breathing because of severe incisional pain

Hypovolemic shock caused by hemorrhage If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.

Acute dialysis is indicated during which situation? Dehydration Metabolic alkalosis Impending pulmonary edema Hypokalemia

Impending pulmonary edema Acute dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema, or increasing acidosis.

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Increase carbohydrates and limit protein intake. Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase protein, carbohydrates, and fat intake.

Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

The nurse is assessing a client who has a unilateral obstruction of the urinary tract. Which clinical finding by the nurse correlates to this diagnosis? Excretion of dilute urine Inability to control urination Increase in blood pressure Increased urine output

Increase in blood pressure Hypertension is an occasional complication of urinary tract obstruction. It is more common in cases of unilateral obstruction in which renin secretion is enhanced, probably secondary to impaired renal blood flow. In these circumstances, removal of the obstruction often leads to a reduction in blood pressure. The urine output would be decreased and not diluted.

What is a characteristic of the intrarenal category of acute renal failure? High specific gravity Increased BUN Decreased creatinine Decreased urine sodium

Increased BUN The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

Empowering the client with a disability will better serve him or her than will promoting dependency. This type of approach is seen in which type of model of disability? Rehabilitation model Social model Interface model Medical model

Interface model In the interface model of disability, the client seeks or directs solutions toward the problem. The interface model may be most appropriate for use by nurses to provide care that is empowering rather than care that promotes dependency.

Following a lengthy series of diagnostic tests, a client's chronic hip pain has been attributed to advanced osteonecrosis. What treatment is this client most likely to require? Joint replacement surgery Transfusion of packed red blood cells Injections of corticosteroids into the synovial space Intravenous antibiotics

Joint replacement surgery

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client? Clean the catheter insertion site daily with soap Wear a mask while handling any dialysate solutions Keep the dialysis supplies in a clean area, away from children and pets Keep the catheter stabilized to the abdomen, below the belt line

Keep the dialysis supplies in a clean area, away from children and pets It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

Which lipid level would the nurse interpret as being high? LDL cholesterol of 190 mg/dL HDL cholesterol of 48 mg/dL Triglyceride level of 160 mg/dL Total cholesterol of 200 mg/dL

LDL cholesterol of 190 mg/dL LDL level of 190 mg/dL would be considered high. A total cholesterol level of 200 mg/dL would be considered borderline high. A triglyceride level of 160 would be borderline high. HDL level of 48 would be considered low to optimal. Levels about 60 mg/dL would be considered high.

Nursing care of patients with chronic illness is varied and occurs in a variety of settings. Care must be direct and supportive. To provide supportive care, a nurse would do which of the following? Provide treatments. Manage the medication regime. Make referrals for additional care. Assess the patient's physical status

Make referrals for additional care. Nursing care of patients with chronic illnesses is varied and occurs in a variety of settings. Care may be direct or supportive. Direct care may be provided in the clinic or health provider's office, the hospital, or the patient's home, depending on the status of the illness.

A client who is an avid runner had an emergency below-the-knee amputation after a motor vehicle accident. The nurse hears a physical therapist tell the client that the client may have to stop running. The nurse considers this comment as an indication that the physical therapist has which frame of reference for caring for clients with disabilities? Biophysical model Medical model Interface model Rehabilitation model

Medical model In this example, the physical therapist's frame of reference, or approach to providing care, stems from the medical model. By telling the client that she would need to stop running, the therapist equated the client with her disability, acted as the authority figure, and promoted the client's dependence, rather than allowing the client to define the problem and seek/direct solutions. Equating the client with the disability, acting as the authority, and promoting passivity and dependence are hallmarks of the medical model of disability.

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? Obstruction of the urinary collecting system Poor perfusion to the kidneys Damage to cells in the adrenal cortex Nephrotoxic injury secondary to use of contrast media

Nephrotoxic injury secondary to use of contrast media Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? Diuresis Oliguria Restored glomerular function Acute tubular necrosis

Oliguria During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? Oliguria Diuresis Initiation Recovery

Oliguria The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.

The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using? General inpatient care Palliative care Continuous care Inpatient respite care

Palliative care Long-term care is increasing as a setting to provide palliative care that addresses management of symptoms such as pain. Inpatient respite care is a 5-day inpatient stay provided on an occasional basis to relieve the family caregivers. Continuous care is provided in the home to manage a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.

The nurse is planning a community education program on disabilities. The nurse plans to include which statement? Greater than 10% of children have a disability. People with disabilities are most likely to work part time. Less than 5% of people in the United States have a disability. Fifty percent of people with disabilities are employed.

People with disabilities are most likely to work part time. People with disabilities are more likely than those without disability to work part time. The employment rate for people with disabilities is 18.6-23.4%. Approximately 20% of the U.S. population has a disability and 5% of children have a disability.

A nurse is talking on the phone with a doctor and states, "I am calling you about Mrs. Nye, my client with cancer in room 213." This is an example of what type of language that is important to all people? Medical jargon People-first First nation Nursing speak

People-first It is important to all people, with and without disabilities, to not be equated with an illness or a physical condition. Therefore, it is important for health care providers to refer to all people using "people-first" language.

Which of the following occurs late in chronic glomerulonephritis? Stroke Peripheral neuropathy Seizure Nosebleed

Peripheral neuropathy Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.

A client presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process? Leukemia Anemia Polycythemia Thrombocytopenia

Polycythemia Unregulated overproduction of the red cell mass is termed polycythemia.

Which stage of shock is best described as that stage when the mechanisms that regulate blood pressure fail to sustain a systolic pressure above 90 mm Hg? Refractory Compensatory Irreversible Progressive

Progressive

What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Proteinuria Hypokalemia Hyperalbuminemia

Proteinuria Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth? Provide gentle oral care after each meal. Place two drops of atropine ophthalmic 1% solution sublingually. Gently suction the client's mouth and buccal cavity. Begin 9% normal saline IV at 125 mL/hr.

Provide gentle oral care after each meal. Dry mouth can generally be managed through nursing measures such as mouth care. The use of artificial hydration (IV fluids) carries considerable risks and does not contribute to comfort at the end of life. Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions. Gentle oral suctioning reduces the production of secretions.

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education? Raising the head of the bed to a high Fowler's position Inserting an IV to begin a normal saline infusion Placing a pulse oximeter on the client to monitor oxygenation status Administration of 2L of oxygen by nasal cannula

Raising the head of the bed to a high Fowler's position

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis Previous episode of acute pyelonephritis

Recent history of streptococcal infection Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate? Comeback Downward Stable Acute

Stable The stable phase indicates that the symptoms and disability are under control or managed. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The comeback phase is the period in the trajectory marked by recovery after an acute period. The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions? Providing evidenced-based advice for end-of-life care based on the nurse's experiences with previous clients in hospice Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care Offering reassurance that the nurse has had 5 years of assisting clients in hospice and their families care for loved ones at the end of life Filling voids in conversation with information related to death and dying to avoid awkward moments during the admission interview

Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care A key to effective listening includes allowing the client and family sufficient time to reflect and respond after asking a question. Hospice nurses with effective listening skills resist the impulse to fill the empty space in communication with talk, avoid the impulse to give advice, and avoid responses indicating, "I know just how you feel."

The client had a cerebrovascular accident with drooping of the face. Speech is slurred. The nurse is obtaining the admission assessment data. It would be best for the nurse to Ask a family member the questions. Chart that the nurse is unable to obtain information. Wait until past medical records can be obtained. Repeat back what the client states.

Repeat back what the client states. When communicating with a client who has speech disabilities or difficulties, the nurse repeats what the nurse understands the client has stated for clarification. The nurse asks questions of the client who is able to provide information, not a family member. The nurse does not chart "unable to obtain the information." The client's situation could have changed since past medical records were written.

A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client? Respect the client's and family members' choices. Ask the family members about spiritual care. Abide by the dying client's wishes. Share emotional pain.

Respect the client's and family members' choices. In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. Sharing emotional pain is a role in providing care and comfort to dying clients and their families. When the client has a living will, physicians must abide by the client's wishes. The nurse should ask the family members about spiritual care only if the client wants someone associated with his or her religion.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Toileting self-care deficit Impaired urinary elimination Risk for infection Activity intolerance

Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

Which of the following would a nurse classify as a prerenal cause of acute renal failure? Prostatic hypertrophy Ureteral stricture Polycystic disease Septic shock

Septic shock Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.

Which of the following is the most sensitive indicator of renal function? Creatinine clearance Blood urea nitrogen (BUN) Potassium Serum creatinine

Serum creatinine Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body.

During the embryonic stage of pregnancy, what changes would the mother note in her body to signal that she is pregnant? Constipation often occurs during this time. She will miss her menstrual cycle. She will have a slower heartbeat. She will begin to gain weight.

She will miss her menstrual cycle.

Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? Tachycardia Shortness of breath A loud, blowing murmur Hypertension

Shortness of breath

What is used to decrease potassium level seen in acute renal failure? IV dextrose 50% Calcium supplements Sorbitol Sodium polystyrene sulfonate

Sodium polystyrene sulfonate The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? Red blood cells in the urine Protein elevation in the urine Sore throat 2 weeks ago Elevation of blood pressure

Sore throat 2 weeks ago Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. Red blood cells and protein found in the urine and elevated blood pressure are symptoms associated with glomerulonephritis.

During which phase of the Trajectory Model of chronic illness is the focus of nursing care on reinforcing positive behaviors and offering ongoing monitoring? Pretrajectory Stable Unstable Trajectory onset

Stable In the Stable phase, the focus of nursing care is on reinforcing positive behaviors and offering ongoing monitoring. During the Pretrajectory phase, the focus is on referring the person for genetic testing and counseling, if indicated, and providing education about prevention of modifiable risk factors and behaviors. The trajectory onset phase provides explanation of diagnostic tests and procedures and reinforces information and explanation given by the primary health care provider. During the Unstable phase of the Trajectory Model, the focus of nursing care is on providing guidance and support and reinforcing previous teaching.

A client with newly diagnosed hypertension on BP medication has been taking her own BP at home for 2 weeks. When she calls and reports her BP readings to the nurse, the nurse notes an elevated BP in the morning. The client states that she wakes up, has her daily cup of coffee, and takes her BP before eating as she was instructed. What should the nurse recommend to this client? Take her BP before drinking her morning cup of coffee. Come immediately into the office to be examined by the health care provider. Only take her BP in the evenings when it seems lower. Take the BP after she eats instead.

Take her BP before drinking her morning cup of coffee. A client should be taught to avoid food, coffee, and alcohol 30 minutes before taking a measurement. There is no need for this client to come immediately to the office; it is usually recommended that clients take their BP in the morning and the evening to get a record of BP readings over time.

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Multiple spiked P waves Tall, peaked T waves Prolonged ST segment Shortened QRS complex

Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.

A biology class is discussing blood flow directions and the role of arteries and veins. The professor says, "The skin is the only place where there is a direct anastomosis between an artery and a vein." What is the purpose for this type of blood flow in the skin? Assist in elimination of toxins from the air Higher need for direct oxygenation Nutrient delivery Temperature regulation

Temperature regulation

The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. The arterial system distributes oxygenated blood to the tissues. The capillaries pump blood. The venous system collects deoxygenated blood from the tissues. The heart exchanges gases, nutrients, and wastes.

The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues.

Which of the following describes the crisis phase of the trajectory model of chronic illness? The client is experiencing a critical or life-threatening situation requiring emergency treatment. The client may require more diagnostic tests. The course of the illness and symptoms are under control. The client is in the final days or weeks before death characterized by gradual or rapid shutting down of body processes.

The client is experiencing a critical or life-threatening situation requiring emergency treatment.

Down syndrome is categorized as a(n) developmental disability. acquired disability. age-related disability. acute nontraumatic disorder.

developmental disability. Examples of developmental disabilities are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.

A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness: The client adheres to the prescribed therapeutic regimen. The client stops taking some medications due to side effects that are disturbing to the client. The client and family do not allow the chronic illness to be the focal point of their lives. The client does not believe that the illness threatens self identity and body image.

The client stops taking some medications due to side effects that are disturbing to the client. Clients who experience a chronic illness may stop taking medications or alter dosages of medications due to side effects that they consider more disturbing or disruptive than the chronic illness. Many clients and their families have the chronic illness become the focal point of their life. For many clients, the effects of the chronic illness threaten identity and body image. Clients have difficulty adhering to a therapeutic regimen due to the realities of daily life and culture, values, and socioeconomic factors.

While assessing a client with urosepsis, the nurse notes the client's blood pressure is 80/54 mm Hg; heart rate is 132 beats/min; respiratory rate is 24 breaths/min; pulse oximetry 89% on 6 lpm O2. Over the last hour, the clients' urine output is 15 mL. When explaining to a new graduate nurse, the nurse will explain which physiologic principle? The ability to transport substances from the tubular fluid into the peritubular capillaries becomes impaired, which results in fluid being forced out of capillaries into the glomerulus. The infection is deep inside the kidney and it will take a long time for the antibiotics to kill the bacteria. The client's sympathetic nervous system has been stimulated, which has resulted in vasoconstriction of the afferent arteriole that in turn causes a decrease in renal blood flow. The glomeruli filtration system gets overwhelmed in times of stress (like infections) and can become clogged with waste material from the bacteria.

The client's sympathetic nervous system has been stimulated, which has resulted in vasoconstriction of the afferent arteriole that in turn causes a decrease in renal blood flow.

The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason? The disabling effects that result from involvement of heart valves That there is no definitive test used for diagnoses The fact that it affects young and old The cost associated with treating the disease

The disabling effects that result from involvement of heart valves Rheumatic fever is a very important cause of heart disease and its most serious and disabling effects result from involvement of the heart valves.

A client with impaired hearing communicates through sign language and has been admitted to the unit before scheduled surgery. The interpreter that the hospital employs is at the bedside. The nurse needs to take what actions into consideration prior to doing preoperative teaching with this client? The interpreter may lag a few words behind--especially if names or technical terms are to be finger spelled. The nurse should talk to the interpreter while teaching the client. An interpreter is not needed. A family member would be better to use as the interpreter.

The interpreter may lag a few words behind--especially if names or technical terms are to be finger spelled. If a nurse is speaking through a sign language interpreter, the interpreter may lag a few words behind-especially if names or technical terms are to be finger spelled. So the nurse should pause occasionally to allow the interpreter time to translate completely and accurately. The facility should provide an interpreter for the client with a disability. Family members should not serve as interpreters due to concern for misinterpretations of information and the need to maintain client privacy and confidentiality. The nurse should talk directly to the person who has hearing loss, not to the interpreter. However, although it may seem awkward, the person with hearing loss will look at the interpreter and may not make eye contact with the nurse during the conversation.

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? The kidneys can improve over a period of months. Acute renal failure tends to turn to end-stage failure. Kidney function will improve with transplant. Once on dialysis, the need will be permanent.

The kidneys can improve over a period of months. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.

The nurse is monitoring a client with a pacemaker. Which finding shows that the client's pacemaker is functioning correctly? The client reported no pacemaker problems with medical history information. The nurse observed a spike on the electrocardiogram (EKG) with pacing initiated. The generator is observed on the chest wall of the client. The nurse palpates bilateral radial pulses.

The nurse observed a spike on the electrocardiogram (EKG) with pacing initiated.

When it is determined that a client's red blood cells (RBCs) have a biconcave shape, what will be the nurse's reaction? The nurse will be pleased, as that shape allows for increased oxygen diffusion. The nurse will arrange for bedside oxygen for the client to use as needed. The nurse will be concerned, as this is an indication of sickle cell anemia. The nurse will immediately notify the client's health care provider of this serious finding.

The nurse will be pleased, as that shape allows for increased oxygen diffusion.

A nurse is assessing the vital signs of a client. The client inquires about the functions of the arteries. What should the nurse include in the client education about the function of arteries? To take the blood back into the heart's chambers To exchange oxygen and nutrients with body cells To carry oxygenated blood to the body cells To serve as a capacitance vessels for blood

To carry oxygenated blood to the body cells

A nurse cares for a client with a chronic illness who has a diagnostic workup for the illness and announces the diagnosis to friends and family. According to the Trajectory Model of Chronic Illness, what phase is the client displaying? Pretrajectory Stable Trajectory onset Acute

Trajectory onset According to the Trajectory Model of Chronic Illness, the trajectory onset phase includes the period of diagnostic workup and announcement of the illness. While the other answer choices are phases of the Trajectory Model of Chronic Illness, these are not the correct answer choices.

Which serum biomarker is highly specific for myocardial tissue? C-reactive protein Troponin White blood cells Creatine kinase

Troponin

Strong evidence exists that atheroma development occurs more quickly in patients with elevated cholesterol and lipid levels. False True

True

A client is hospitalized with a traumatic brain injury following an automobile accident. The client has difficulty processing information and needs information to be repeated. A consulting physician enters the room. The nurse Removes unnecessary items from the beside table while the physician meets with the client Turns off the television Leaves the room Communicates with the daughter while the physician talks with the client

Turns off the television The nurse minimizes distractions so the client can focus on one thing, such as the physician who may impart important information. Distractions are having the television on, cleaning the room, and talking with someone else in the room. The nurse does not leave the room. The nurse remains so she can repeat information provided by or to the client.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? Blood urea nitrogen (BUN) level of 22 mg/dl Temperature of 100.2° F (37.8° C) Serum creatinine level of 1.2 mg/dl Urine output of 250 ml/24 hours

Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

In spite of administering the prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea? Offer small amounts of nourishment frequently Use imagery, humor, and progressive relaxation Encourage the patient to sleep Gently massage the arms and legs

Use imagery, humor, and progressive relaxation Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help potentiate the effects of pain medication.

A client experiencing a manic phase of bipolar disorder sustained cuts on the body from falling through a store window. The nurse is preparing to start an intravenous needle insertion. How should the nurse explain the procedure to the client? Giving specific details about the procedure and what is going to happen next Using clear and simple terms Interrupting the client's ravings Ignoring the client's statement of, "I don't want this."

Using clear and simple terms When communicating with clients who have psychiatric or mental health disabilities, the nurses uses clear and simple communication. The nurse needs to listen to the client and wait for the client to finish speaking. The client makes independent decisions, and the nurse does not ignore the client's refusal.

Which dysrhythmia is considered to be the most fatal and requires immediate treatment? Premature atrial contractions Atrial flutter Ventricular fibrillation Premature ventricular contractions

Ventricular fibrillation

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? Avoid carrying heavy items. Auscultate the lungs frequently. Wear a mask when performing exchanges. Perform deep-breathing exercises vigorously.

Wear a mask when performing exchanges. The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? At bedtime with 8 ounces of fluid 2 hours before meals With food 2 hours after meals

With food Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.

The nurse should use the bell of the stethoscope during auscultation of: a client's heart murmur. a client's breath sounds. a client's apical heart rate. a client's bowel sounds.

a client's heart murmur. The bell of the stethoscope is used to listen to low-pitched sounds, such as heart murmurs. The diaphragm of the stethoscope is used to listen to high-pitched sounds such as normal heart sounds, breath sounds, and bowel sounds.

The nurse is caring for a client with coronary artery disease and hypertension. The nurse explains to the client that coronary artery disease disables what process that controls blood pressure? ability of the arterioles to increase or decrease resistance ability of the venules to return blood to the veins capacitance system oncotic pressure

ability of the arterioles to increase or decrease resistance

A change that occurs during chronic glomerulonephritis is termed hypokalemia. metabolic alkalosis. anemia. hypophosphatemia.

anemia Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur during chronic glomerulonephritis.

nurse is giving instructions to parents of a school-age child diagnosed with sickle cell anemia. The instructions should include: avoiding areas of low oxygen availability such as high altitudes. encouraging the child to exercise to reduce the likelihood of crisis. restricting the child's fluids during crisis situations. applying cold to affected areas to reduce the child's discomfort.

avoiding areas of low oxygen availability such as high altitudes.

When performing an assessment on a school-aged child, the nurse notes that the mucous membranes along the gum margins have a noticeable blue-colored line. At this point, the nurse should ask the parents about possible: liver problems as an infant. exposure to lead. congenital heart problems. second-hand smoke exposure.

exposure to lead.

An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by: selectively blocking the synthesis of renin in the kidneys. promoting cardiac output through a reduction in afterload. blocking the conversion of angiotensin I to angiotensin II. enhancing inotropy by maximizing calcium channel function.

blocking the conversion of angiotensin I to angiotensin II. ACE inhibitors block the conversion of angiotensin I to angiotensin II. They do not directly affect renin synthesis, calcium channel function, or afterload.

The nurse is caring for a client in active labor. As the nurse is evaluating the fetal heart rate pattern below, identify the area of concern that suggests umbilical cord compression.

bottom of the U Variable decelerations are decreases in fetal heart rate that aren't related to the timing of contractions. Characteristic of umbilical cord compression, variable decelerations generally occur as drops of 10 to 60 beats/minute below the baseline.

An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension? decreased elasticity of the venous connective tissue increased elasticity of the venous connective tissue decreased elasticity of the aorta and large arteries increased elasticity of the arterial connective tissue

decreased elasticity of the aorta and large arteries In aging adults, there is a decrease in the elasticity of the aorta and large arteries making them more rigid, thereby increasing systolic blood pressure. This can lead to increased cardiac afterload and hypertension.

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: fatigue and weakness. dyspnea and cyanosis. thrush and circumoral pallor. nausea and vomiting.

fatigue and weakness. RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

A nurse is caring for a client with a cast on their left arm after sustaining a fracture. Which assessment finding is most significant for this client? presence of a normal popliteal pulse cast edges are rough, with skin irritation present fingers on the left hand are swollen and cool minimal pain in the left arm

fingers on the left hand are swollen and cool

A nurse will be providing care for a female client who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which statement best describes the presentation that the nurse should anticipate? The client: has a distended bladder, facial edema, and difficulty breathing during nighttime hours. has cyanotic lips and extremities, low urine output, and low blood pressure. complains of dyspnea and has adventitious breath sounds on auscultation (listening). has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

A client has developed heart failure. The doctor reviews the client's chest x-ray and notes that the heart has enlarged. The changes in the size and shape of the heart are the result of: hypoplasia. hyperplasia. atrophy. hypertrophy.

hypertrophy

A cause related to the increasing number of people with chronic conditions is improved screening and diagnostic procedures. a tendency for these conditions to develop in younger people. shorter lifespans. an increase in mortality from infectious disease.

improved screening and diagnostic procedures. The increasing number of people with chronic conditions is related to improved screening and diagnostic procedures. Mortality from infectious diseases has been decreasing. Chronic conditions tend to develop in the elderly population. People are living longer for various reasons.

A client has been diagnosed with acute glomerulonephritis. This condition causes: proteinuria. polyuria. pyuria. No option is correct.

proteinuria The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.

A pregnant client is admitted to a maternity clinic after experiencing contractions. The assigned nurse observes that the client experiences pauses between contractions. The nurse knows that which event marks the importance of the pauses between contractions during labor? shortening of the upper uterine segment restoration of blood flow to uterus and placenta reduction in length of the cervical canal effacement and dilation (dilatation) of the cervix

restoration of blood flow to uterus and placenta The pauses between contractions during labor are important because they allow the restoration of blood flow to the uterus and the placenta. Shortening of the upper uterine segment, reduction in length of the cervical canal, and effacement and dilation (dilatation) of the cervix are other processes that occur during uterine contractions.

In the intensive care unit (ICU), the nurse is caring for a trauma client who has abdominal injuries, is beginning to have a decrease in BP and increased pulse rate, and is pale with diaphoretic skin. The nurse is assessing the client for hemorrhagic shock. If the client is in shock, the nurse would expect to find: excess output of blood-tinged urine. complaints of flank pain rotating around the abdominal muscles. an increase in GFR due to relaxation of the afferent arterioles. significant decrease in urine output due to decrease in renal blood flow.

significant decrease in urine output due to decrease in renal blood flow.

What position should the nurse use for the client with venous insufficiency to enhance blood supply? prone with head turned to one side Fowler with lower extremities in neutral position supine with lower extremities elevated dorsal recumbent with legs separated

supine with lower extremities elevated

A pulse deficit is the difference between: the systolic and diastolic blood pressure readings. the apical and the radial pulse rates. palpated and auscultated blood pressure readings. the radial pulse and the ulnar pulse rates.

the apical and the radial pulse rates.

A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color, and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which complication? edema in the right leg thrombosis in the right leg compartment syndrome in the right leg infection in the right leg

thrombosis in the right leg

A clinical nurse specialist is interested in developing a research study focused on clients living with the sequelae of ischemic stroke. Which clients should the nurse include? Select all that apply. The nurse should include clients with: vision changes. falls. unilateral weakness. dysphagia (difficulty swallowing). aspiration pneumonia.

unilateral weakness. dysphagia (difficulty swallowing). vision changes.

A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life? drop in blood pressure and rapid heart rate irregular eating habits altered gastrointestinal function weight loss and inadequate food intake

weight loss and inadequate food intake The nurse should report weight loss and inadequate food intake so that the team can consider adding appetite stimulants and the nutritionist can alter the meal plan to give more satisfying meals as a comfort measure. The nurse knows that changes of gastrointestinal function such as irregular eating or bowel changes occur as part of the dying process and are not relevant to the desired intervention. Deteriorating vital signs are part of the dying process so that these signs are not relevant to the desired intervention.