finals 1020 backward
A nurse is discussing the regaining of bowel control with a client who recently had surgery for a colostomy in the descending colon. What is most important to emphasize in this teaching? 1 Irrigation routine 2 Management of fluid intake 3 Progressive exercise program 4 Maintenance of a low-residue diet
1 Irrigation routine
A nurse is assessing a client with the diagnosis of hemorrhoids. Which factors in the client's history most likely played a role in the development of the client's hemorrhoids? Select all that apply. 1 Constipation 2 Hypertension 3 Eating spicy foods 4 Bowel incontinence 5 Numerous pregnancies
1 Constipation 5 Numerous pregnancies
What is Oliguria?
100-400mL/24hr period elimination
What is the therapeutic range for sodium?
135-145
A client comes to the emergency department because of minimal urinary output despite drinking adequate fluid. The client's blood pressure is 190/94 mm Hg. For what additional clinical manifestation associated with this data should the nurse assess the client? 1 Thirst 2 Weight gain 3 Urinary retention 4 Urinary hesitancy
2 Weight gain
What is the therapeutic range for potassium?
3.5-5.0mEq/L
What is parkinson disease?
A progressive degenerative nerologic disorder that primarily affects movement. Not enough dopamine in the body.
What are focal seizures?
Activity contained to a limited area in the brain
What is acute pyelonephritis?
Acute inflammatory process of one/both kidneys. Kidney can become edematous. Caused by bacteria (E coli) typically
What medications can be used for a patient with CD?
Aminosalicylates- Mesalamine (Asacol) Glucocorticoids- Prednisone (Deltasone) Antidiarrheal- Lopeeramide (Imodium) Immunomodulators- Adalimumab (Humira)
What medications should be used for someone with UC?
Aminosalicylates- mesalamine (asacol) Glucocorticoids- Prednisone (Deltasone) Antidiarrheal- Loperamide (Imodium) Immunomodulator- Adalimumab (Humira)
What is an embolic stroke?
An emboli originated from other parts of the body and a micro emboli breaks off from sclerosis plaque. Type of ischemic stroke
What is Gastroesophageal reflux disease (GERD)?
Backward flow of gastric contents into the esophagus.
What are the treatments for acute pyelonephritis?
Broad spectrum IV antibiotic initally, then targeted po, analgesics, antipyretics, antiemetic
What diagnostic tests dx diverticular disease?
CT scan, ultrasound, MRI, CBC, BMP, Urinalysis, stool sample for occult blood.
What should be avoided for patients with UC?
Caffeine, alcohol, smoking, lactose containing foods, raw vegetables, high fiber foods, carbonated drinks, pepper, corn, foods with seeds, nuts, dried fruits
What is transurethral resection of the prostate (TURP)?
Closed procedure where small pieces of the prostate are removed.
What are the clinical manifestations of Crohn disease?
Constant pain in the right lower quadrant. Fever, anorexia, wt loss, fatigue, anemia, 5-6 soft loose stool per day w/o blood. nausea, vomiting, bowel strictures and obstructions.
What are some nursing key points for UC?
Controlling diarrhea/promoting optimal bowel functioning, prevention of complications, promoting optimal nutrition, helping minimize emotional stressors, teaching
What diagnostic tests are done to dx Parkinson Disease?
Datscan, MRI, blood tests
What is the treatment for CD?
Develop nutrition and healthy lifestyle habits, anti-inflammatory agents, immunosuppressants, anti-tumor necrosis factor agents, antibiotics, probiotics, surgery if needed (70-75% patients may require surgery at some point to relieve symptoms, is rarely curative).
What does EGFR stand for and mean?
Estimated glumerial filtration rate
What Diagnostic tests are used to dx UC?
H&H( low), WBC, C-reactive protein & erythrocyte sedimentation rate (high), Na+, K+, Chloride (may be low), serum albumin (may be low), MRE, Colonoscopy, CT scan, barium enema
What is an absent seizure?
Has no aura, brief LOC, blank stare, may have little tonic-clonic movement, no postictal state
What are some complications of UC?
Hemorrhage, perforation, fulminant colitis (>10 stool w/blood), Toxic mega-colon, colorectal cancer
What is Cushings Triad?
ICP= high BP, low Pulse, low Respirations Shock= low BP, high Pulse, high Respirations
How is chronic pyelonephritis diagnosed?
IV urogram, creatinine clearance, serum BUN/Creatinine levels
How is UTC treated?
NSAIDs-for pain Anti-nausea: promethazine Hot bath, moist heat, relaxation technique, positioning. Cystoscopy/ ureteroscopy, lithotripsy, ureterolithotomy, pyelolithotomy, nephrolithotomy
What is a stroke?
Neurologic deficit result from sudden decrease in blood flow to a localized area on the brain.
What is needed for a urinalysis?
Procedure is clean; not sterile. 30mL of urine is needed.
What is Nephrolithiasis?
Stones in the kidney
What Urolithiasis?
Stones in the urinary tract
What diagnostic test should be done to dx CD?
Stool sampling to rule out infectious causes of diarrhea, C-reactive protein and erythrocyte sedimentation rate, CBC, lower endoscopy, barium studies
What are the clinical manifestations of Diverticulosis and diverticulitis?
Sudden and constant abdominal pain in the left lower quadrant, abdominal distention, nausea, diarrhea, constipation, decreased appetite, fever, tachycardia, and hypotension.
What are dx tests for UTC?
U/A- RBCs, WBCs, C&S, serum WBC, calcium, uric acid, oxalate, phosphate. KUB, IVP, renal ultrasound, CT, Cystoscopy
What is a culture and sensitivity test?
Urinary test that tests what grows (culture) and what will best treat the growth (sensitivity)
What surgical interventions can be done for PD?
deep brain stimulation
What are generalized seizures?
discharges originate from both hemispheres of the brain.
What Does FAST stand for with strokes?
face, arms, speech, time
What are risk factors for developing stones in the renal system?
family hx, dehydration, immobility, infection, obstruction, elevated uric acid, hyperparathyroidism, defective oxalate metabolism, renal tubular necrosis, polycystic kidney disease
What is polyuria?
greater than 2L/24hr period elimination
What are the possible causes of seizures?
head trauma, brain tumors/aneurysms, vascular disease, medication/drugs, kidney and liver failure
What is associated with the postictal phase of a tonic-clonic seizure?
lethargy, weakness, fatigue, muscle soreness, may last several minutes to hours
What are the clinical manifestations of BPH?
weak and intermittent urinary stream, increased risk of lower UTI, hesitancy, dribbling, straining during urination, frequency, urgency, incontinince, dysuria
What is normal Creatinine range?
0.8-1.3
The nurse is providing postoperative care 8 hours after a client had a total cystectomy and the formation of an ileal conduit. Which assessment finding should be reported immediately? 1 Edematous stoma 2 Dusky-colored stoma 3 Absence of bowel sounds 4 Pink-tinged urinary drainage
2 Dusky-colored stoma
What is the normal BUN range?
8-21
What diagnostic tests should be done for someone with a stroke?
CBC, cardiac enzymes, PT/INR, CT, MRI, carotid duplex, ECG, echocardiogram.
What foods should be avoided with diverticular disease?
Corn, peanuts, chinese vegetables, string beans, shrimp and lobster, rice, bran, vegtables with skin,. foods with seeds.
How is BPH diagnosed?
Digital rectal exam: reveals a large, firm, smooth prostate U/A, urince culture
What are the treatments for diverticular disease?
High fiber diet for diverticulosis, low fiber and rest for diverticulitis. Clear liquid diet, oral broad-spectrum antibiotics, and follow-up. If needed, surgical intervention.
What is Continuous Bladder Irrigation?
Keeps clots from causing an obstruction
What is Anuria?
Less than 100mL/24hr period elimination
How is chronic pyelonephritis treated?
Prophylactic antimicrobials (bactrim)
A client with an invasive carcinoma of the bladder is receiving radiation to the lower abdomen in an attempt to shrink the tumor before surgery. What should the nurse do, considering the side effects of radiation? 1 Observe the feces for the presence of blood. 2 Monitor the blood pressure for hypertension. 3 Administer enemas to remove sloughing tissue. 4 Provide a high-bulk diet to prevent constipation.
1 Observe the feces for the presence of blood.
A client is scheduled for a transurethral resection of the prostate. What should the nurse tell the client to expect after surgery? 1 "Urinary control may be permanently lost to some degree." 2 "An indwelling urinary catheter is required for at least a day." 3 "Your ability to perform sexually will be impaired permanently." 4 "Burning on urination will last while the cystostomy tube is in place."
2 "An indwelling urinary catheter is required for at least a day."
What is the therapeutic range for calcium?
8.5-10.5
What medications are given to patients to control seizure activity?
Carbamazepine, gabapentin, levetiracetam, phenobarbital, phenytonin, divalproex, diazepam, lorazepam, lamotrigine, topirate
normal hematocrit levels?
Men: 42-52% Women: 37-47%
What is Benign prostatic hyperplasia?
Nonmalignant enlargement of the prostate gland. It obstructs outflow of urine by obstructing the urethra, causing incomplete emptying of the bladder and urinary retention.
A client who had surgery for a resection of the colon and the formation of a colostomy is to be discharged in several days. What is a primary nursing intervention for this client? 1 Determine the client's ability to care for the colostomy 2 Show the client how to change the abdominal dressing 3 Encourage the client to apply heat to the stoma opening 4 Teach the client about the special lifelong dietary precautions
1 Determine the client's ability to care for the colostomy
A client has a permanent sigmoid colostomy, and colostomy irrigations are prescribed. The client asks the nurse why they are needed. How should the nurse respond? 1 "Less fluid is lost from the intestine." 2 "They help establish an elimination schedule." 3 "They decrease the amount of flatus in the bowel." 4 "Straining is minimized during a bowel movement."
2 "They help establish an elimination schedule."
A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end-stage renal disease (ESRD)? 1 Fluid 2 Protein 3 Sodium 4 Potassium
2 Protein
Normal phosphate levels?
2.5-4.5 mg/dL
A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed? 1 It equals the expected urinary output for the next 24 hours. 2 It will prevent the development of pneumonia and a high fever. 3 It will compensate for both insensible and expected output over the next 24 hours. 4 It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.
3 It will compensate for both insensible and expected output over the next 24 hours.
Part of discharge teaching for a client with a sigmoid colostomy includes how to protect clothing from colostomy leakage. What is the nurse's most appropriate response when the client asks about the use of appliances and dressings? 1 "Appliances are used to avoid soiling clothing." 2 "Special appliances are expensive, but they provide for better bowel control." 3 "Enough appliances will be given to last until the next visit to the primary healthcare provider." 4 "Many people do not need appliances once they regulate the bowels with routine irrigations."
4 "Many people do not need appliances once they regulate the bowels with routine irrigations."
A client with a left ureteral calculus is scheduled for a transurethral ureterolithotomy. During the preoperative assessment, how does the nurse expect the client to report pain? 1 It is a boring-type pain that is located in the left flank. 2 It is dull and constant and located in the costovertebral angle. 3 It is located at the level of the kidneys and occurs with each urination. 4 It is spasmodic and located in the left side and radiating to the suprapubic area.
4 It is spasmodic and located in the left side and radiating to the suprapubic area.
What medications is used for men with BPH?
5-a-reductase inhibitors, alpha-adrenergic receptor blockers, herbal therapy-saw palmetto
What is the therapeutic range for chloride?
97-107
What diagnostic tests are used to dx acute pyelonephritis?
CBC, blood cultures, UA, urine for C/S, urine for gram stain, IVP, KUB, US, CT scan, voiding cystourethrography, cystoscopy
What medications are used for a PD patient?
Carbidopa-levadopa, bromocriptine, pramipexole, ropinirole, benztropine, trihxyphenidyl, comtan, eldepril
What are the clinical manifestations of acute pyelonephritis?
Chills, fever, leukocytosis, low back pain, flank pain, CVA tenderness, N/V, general malaise, painful urination
What is Ulcerative Colitis?
Chronic inflammatory condition limited to the mucosal layers of the colon. Relapsing and remitting episodes of inflammation.
What is Crohn disease?
Chronic inflammatory condition that may involve any portion of the GIT. Transmural inflammation of the bowel and most commonly affects the ileum and proximal colon.
What suggestion should the nurse provide to the mother whose child has had constipation for three days? Select all that apply. 1 Give laxatives to the child. 2 Reduce the child's fluid intake. 3 Include dairy products in the child's diet daily. 4 Increase the child's physical activity. 5 Include food with a high fiber content in the child's diet.
Correct1 Give laxatives to the child. Correct4 Increase the child's physical activity. Correct5 Include food with a high fiber content in the child's diet.
What is an ischemic stroke?
Disruption of the blood supply due to an occlusion of a cerebral artery, caused by a thrombus or emboli, that causes infarction of brain tissue
What is the difference between between Diverticulosis and Diverticulitis?
Diverticulosis- small herniations of the colonic mucosa through the muscle layers of the colon wall without inflammation Diverticulitis- small herniations of the colonic mucosa through the muscle layers of the colon wall with inflammation
What are the risk factors for a stroke?
Hypertension, heart disease, diabetes mellitus, sleep apnea, blood cholesterol levels, smoking, sickle cell disease, substance abuse, ethnicity, family history, obesity
What are the clinical manifestations of tonic-clonic seizures?
Immediate LOC, tonic phase, clonic phase, postictal phase, may have incontinence
Normal Hemoglobin levels?
Male: 13-18 g/100mL Female: 12-16 g/100mL
What are the clinical manifestations of Parkinsons disease?
Motor- Tremors, muscle rigidity, bradykinesia Face- mask like face (drooling, difficulty chewing and swallowing) Speech- soft, low pitched, dysarthria (unclear speech, otherwise linguistically normal), echolalia, hypophonia Postural- stooped, flexed trunk/forward, extension, abducted/flexed fingers
What is Peptic Ulcer Disease (PUD)?
Painful sores in the lining of the stomach.
What is a hemorrhagic stroke?
Primarily caused by intercerebral or subarachnoid hemorrhage. Bleeding into brain tissue, ventricles, or subarachnoid space.
What foods should patients with Crohn disease avoid?
Caffeine, alcohol, lactose containing food, raw vegetables, high fiber foods, carbonated beverages, pepper, corn, nuts, dried fruits, anything with seeds
Which dietary changes does the nurse suggest for a client who has diarrhea associated with human immunodeficiency virus (HIV disease)? Select all that apply. 1 "Eat more fatty food." 2 "Eat much less roughage." 3 "Drink two cups of coffee daily." 4 "Eat more spicy and sweet food." 5 "Drink plenty of fluids between meals."
Correct2 "Eat much less roughage." Correct5 "Drink plenty of fluids between meals."
What non-pharmacologic therapies are used for patients with PD?
Exercise, physical therapy, occupational therapy, speech therapy
What are the clinical manifestations of chronic pyelonephritis?
Fatigue, anorexia, polyuria, excessive thirst, wt loss, progressive scaring of kidney resulting in renal failure if persistent and recurring infection.
What are clinical manifestations of UTC?
Intense deep ache in costovertebral region, hematuria, pyuria, nausea, vomiting, pallor, diaphoresis, flank pain on side of affected kidney, renal colic
What are the treatments for UC?
NPO and TPN (severe symptoms), plenty of rest, restorative or total proctocolectomy with ileo pouch. Surgery is usually considered curative.
What are the clinical manifestations of a stroke?
Numbness or weakness of face, arms, or legs especially on one side, confusion, trouble speaking or understanding speech, visual disturbances, difficulty walking, loss of balance, dizziness, sudden severe headache
What is chronic pyelonephritis?
Occurs from repeated bouts of acute pyelonephritis. Result of inflammatory process, non bacterial infections.
What is the primary nursing goal for CD and UC?
Optimizing the patient's quality of life by treating acute processes, inducing and maintaining remission, and decreasing the use of corticosteroids.
A healthcare provider prescribes tolterodine for a client with an overactive bladder. What is most important for the nurse to teach the client to do? 1 Maintain a strict record of fluid intake and urinary output. 2 Chew the extended-release capsule thoroughly before swallowing. 3 Report episodes of diarrhea or any increase in respiratory secretions. 4 Avoid activities requiring alertness until the response to medication is known.
4 Avoid activities requiring alertness until the response to medication is known.
After reviewing the 24-hour urine collection reports of a client with kidney dysfunction, the nurse suspects diabetes mellitus. Which finding supports this suspicion? 1 Calcium level: 500 mg/24 hr 2 Sodium level: 300 mEq/24 hr 3 Urea nitrogen level: 30 g/24 hr 4 Creatinine level: 40 mg/kg/24 hr
4 Creatinine level: 40 mg/kg/24 hr
An emergency department nurse assesses an older client who reports cramping pain in the left lower quadrant, weakness, bloating, and malaise. The client also has a low-grade fever. Which condition does the nurse suspect as the most likely cause of the client's clinical findings? 1 Pancreatitis 2 Appendicitis 3 Cholecystitis 4 Diverticulitis
4 Diverticulitis
During administration of an enema, a client reports having intestinal cramps. What should the nurse do? 1 Discontinue the procedure. 2 Instill the fluid at a slower rate. 3 Lower the height of the container. 4 Stop the fluid until the cramps subside
4 Stop the fluid until the cramps subside.
What are the clinical manifestations of Ulcerative Colitis?
5-30 liquid bloody stools per day, colicky pain, sudden urgency to defecate, malaise, anorexia, malnutrition, anemia, dehydration/hypovolemia, fever, severe anxiety and depression.
What is a thrombotic stroke?
A clot that forms on the blood vessel. Associated with arterialsclerosis. The process occures over many years. Usually has a slower onset. Type of ischemic stroke