Med Surg 1 Final Exam Practice Questions

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure? 145/95 or lower 130/80 or lower 150/95 or lower 125/85 or lower

130/80 or lower

A client with a long-standing diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the client for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A. Infection B. Acute pain C. Acute confusion D. Impaired urinary elimination

A

A nurse is caring for a client newly diagnosed with type 1 diabetes. The nurse is educating the client about self-administration of insulin in the home setting. The nurse should teach the client to do what action? A. Avoid using the same injection site more than once in 2 to 3 weeks. B. Avoid mixing more than one type of insulin in a syringe. C. Cleanse the injection site thoroughly with alcohol prior to injecting. D. Inject at a 45-degree angle.

A

adults over 60

42.8% are obese

A nurse is assisting with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? A 16-year-old girl A 40-year-old African-American man A 50-year-old Caucasian woman An Asian adult man

A 40-year-old African-American man

The nurse is caring for a respiratory client who uses a noninvasive positive pressure device. Which medical equipment does the nurse anticipate to find in the client's room?

A face mask

Doppler Ultrasound Flow Studies

A handheld continuous wave (CW) doppler ultrasound device used to detect the blood flow in vessels Used when pulses cannot be reliably palpated

43. is a prostatic pain without evidence of infection or inflammation.

ANS: Prostatodynia Prostatodynia is a prostatic pain without evidence of infection of inflammation. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1692 OBJ: 8 TOP: Prostatodynia KEY: Nursing Process Step: Assessment

42. The prostatectomy technique, which involves an incision through the abdomen and the bladder, is a prostatectomy.

ANS: suprapubic A suprapubic prostatectomy involves an incision through the abdomen and the bladder with removal of the gland with the finger. PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 1702-1703, Table 49-3 OBJ: 3 TOP: Prostatectomy KEY: Nursing Process Step: Assessment

37. Which of the following are signs of fluid overload in the patient with nephrosis? (Select all that apply.) a. Increase in pulse rate b. Increase in daily weight c. Clear lung sounds d. Edema e. Labored respirations

ANS: A, B, D, E Signs and symptoms of fluid overload: changes in pulse rate, respirations, cardiac sounds, and lung fields. Increase in daily morning weights. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1681 OBJ: 7 TOP: Fluid overload KEY: Nursing Process Step: Assessment

9. A 56-year-old patient with cancer of the bladder is recovering from a cystectomy with an ileal conduit. What is an important aspect in nursing interventions of the patient with an ileal conduit? a. Instructing the patient to void when the urge is felt. b. Maintaining skin integrity. c. Limiting oral intake to 1000 mL/day d. Limiting acid-ash foods.

ANS: B Care of the patient with an ileal conduit is a nursing challenge because of the continual drainage of urine through the stoma. Complications of this procedure are wound infection, dehiscence, and urinary leakage. The patient is urged to drink adequate fluids to flush the conduit. PTS: 1 DIF: Cognitive Level: Application REF: Page 1719 OBJ: 8 TOP: Cystectomy KEY: Nursing Process Step: Implementation

The nurse is providing patient teaching to a patient with early stage Alzheimer's disease (AD) and her family. The patient has been prescribed donepezil hydrochloride (Aricept). What should the nurse explain to the patient and family about this drug? A. It slows the progression of AD. B. It cures AD in a small minority of patients. C. It removes the patient's insight that he or she has AD. D. It limits the physical effects of AD and other dementias.

A. It slows the progression of AD. There is no cure for AD, but several medications have been introduced to slow the progression of the disease, including donepezil hydrochloride (Aricept). These medications do not remove the patient's insight or address physical symptoms of AD.

Tophi

Accumulation of crystalline deposits in articular surfaces of bone, soft tissue and cartilage

Polyarticular arthritis

Affects more than one joint

Monoarticular arthritis

Affects one joint

22. A nurse is addressing the incidence and prevalence of HIV infection among older adults. What principle should guide the nurses choice of educational interventions? A) Many older adults do not see themselves as being at risk for HIV infection. B) Many older adults are not aware of the difference between HIV and AIDS. C) Older adults tend to have more sex partners than younger adults. D) Older adults have the highest incidence of intravenous drug use.

Ans: A Feedback: It is known that many older adults do not see themselves as being at risk for HIV infection. Knowledge of the relationship between HIV infection and AIDS is not known to affect the incidence of new cases. The statements about sex partners and IV drug use are untrue.

18. A nurse is caring for a patient hospitalized with AIDS. A friend comes to visit the patient and privately asks the nurse about the risk of contracting HIV when visiting the patient. What is the nurses best response? A) Do you think that you might already have HIV? B) Dont worry. Your immune system is likely very healthy. C) AIDS isnt transmitted by casual contact. D) You cant contract AIDS in a hospital setting.

Ans: C Feedback: AIDS is commonly transmitted by contact with blood and body fluids. Patients, family, and friends must be reassured that HIV is not spread through casual contact. A healthy immune system is not necessarily a protection against HIV. A hospital setting does not necessarily preclude HIV infection.

Which is a potential complication of a low pressure in the endotracheal tube cuff?

Aspiration pneumonia

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as

Atelectasis

Hallmark of rheumatologic disease

Autoimmunity Body recognizes self as foreign

28. A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse's response? A) Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B) All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C) Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D) Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.

B Feedback: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.

4. A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication? A) Sexual stimulation is not needed to obtain an erection. B) The drug should be taken 1 hour prior to intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) The drug has the potential to cause permanent visual changes.

B Feedback: The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may occur, but these are transient.

29. A patient has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action? A) Cleanse the skin surrounding the suprapubic tube. B) Inform the urologist of this finding. C) Remove the suprapubic tube and apply a wet-to-dry dressing. D) Administer antispasmodic drugs as ordered.

B Feedback: The physician should be informed if there is significant leakage around a suprapubic catheter. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

Which statement is true about both lung transplant and bullectomy?

Both procedures improve the overall quality of life of a client with COPD.

Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply.

Compromised gas exchange Decreased airflow Wheezes

Capillaries

Connect arteries and veins Exchange area

Assessment of the Vascular System

Health History ~Obtain description from the patient with PVD (Peripheral Arterial Disease) of any pain and its precipitating factors ~Intermittent claudication (arterial) ~"rest pain" and location of pain Physical Assessment ~Skin- Appearance- Cool, pallor, rubor, loss of hair, brittle nails, dry or scaling skin, atrophy, or ulcerations

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.) Heart rate Respiratory rate Heart rhythm Character of apical and peripheral pulses Lung sounds

Heart rate Heart rhythm Character of apical and peripheral pulses

Ischemia!

Deficient blood supply

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?

Fat embolism syndrome

5. A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A) Red wine colored B) Tea colored C) Amber D) Light pink

D Feedback: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?

Hemorrhage and shock

Which of the following is the key underlying feature of asthma?

Inflammation

S/S of Diffuse Connective Tissue (Dz-RA)

Joint pain + stiffness Swelling Warmth Lack of function to affected areas

The nurse is developing a teaching plan for a client diagnosed with hypertension. What would be important for the nurse to emphasize as part of the plan of care? Limiting sodium intake in the diet Limiting cigarette smoking to 1 pack a week Limiting alcohol to a can of beer to four times a day to thin the blood Limiting activity to prevent over exertion

Limiting sodium intake in the diet

Leg Ulcers Manifestations/Assessments

Manifestations Arterial ~Intermittent claudication (comes with comorbidities) ~Pain (unrelenting not relieved from opioids) ~Ulcers are small, circular, deep ulcerations Venous ~Aching, heavy sensation ~May have edema ~Ulcers are large, superficial, and highly exudative (moist/wet) Assessments ~Identify cause ~History and pulses ~Doppler and duplex ultrasound, arteriography, venography

Cellulitis

Manifestations ~Localized swelling or redness, warmth, pain, and systemic signs such as fever, chills, sweating Medical ~Treat with oral or IV antibiotics based on severity Nursing ~Elevate ~Warm, moist packs to site every 2-4 hr ~Educate regarding prevention of recurrence ~Reinforce education about skin and foot care

A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside?

Manual resuscitation bag

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by?

Mast cells

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? a) Fat embolism b) Avascular necrosis c) Osteomyelitis d) Compartment syndrome

Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

Where are rheumatoid nodules found?

Over bony prominences

Interventions for acute attack of Gout

Pain medication Corticosteroids Probenecid Serum uric acid concentrations Dietary consult

A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessments is significant in diagnosing this client with flail chest?

Paradoxical chest movement

As status asthmaticus worsens, the nurse would expect which acid-base imbalance?

Respiratory acidosis

Which finding indicates that hypertension is progressing to target organ damage? Retinal blood vessel damage Urine output of 60 mL over 2 hours Blood urea nitrogen concentration of 12 mg/dL Chest x-ray showing pneumonia

Retinal blood vessel damage

Community Infection Methods

Sanitation techniques, regulated health practices, food preparation, immunization program

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment?

Signs of neurovascular compromise

T/F SLE has no known triggers

True

Standard Precautions

Used for all patients • Primary strategy for preventing health care-associated infection (HAI)

Exercise Testing

Used to determine how long a patient can walk and to measure the ankle systolic bp in response to walking

A client with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the client has been prescribed?

With meals

Diarrhea Hydration Status

Thirst, dry mucous membranes, weak pule, loss of skin turgor, sunken eyes, I&O

Estimated calorie needs

age, gender, activity level, life stage, disease infection and stress

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You need to perform weight-bearing exercises twice a week." b) "You will receive IV antibiotics for 3 to 6 weeks." c) "You need to limit the amount of protein and calcium in your diet." d) "Use your continuous passive motion machine (CPM) 2 hours each day."

"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks.

A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? A. Ask the client to describe the process in detail. B. Observe the client drawing up and administering the insulin. C. Provide a health education session reviewing the main points of insulin delivery. D. Review the client's first hemoglobin A1C result after discharge.

B

1. An adolescent is identified as having a collection of fluid in the tunica vaginalis of his testes. The nurse knows that this adolescent will receive what medical diagnosis? A) Cryptorchidism B) Orchitis C) Hydrocele D) Prostatism

C Feedback: A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes. Cryptorchidism is the most common congenital defect in males, characterized by failure of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors. Prostatism is an obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections.

CDC

CDC publications, guidelines, web site

Veins

Deoxygenated blood

Is the following statement true or false? A carrier is a person who provides living conditions to support a microorganism.

False. A host is a person who provides living conditions to support a microorganism. A carrier is a person who carries an organism without apparent signs and symptoms and is able to transmit an infection to others.

What indicates renal involvement of SLE?

Hypertension

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.

Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange

How does rheumatic disease most commonly manifest?

Joint pain and inflammation

A client has acute bacterial rhinosinusitis for several weeks despite treatment. The nurse observes for a possible complication of the infection by assessing for

Nuchal rigidity

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

Numbness and burning of the foot

Elderly clients who fall are most at risk for which injuries?

Pelvic fractures

The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient?

Respiratory alkalosis

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

Respiratory rate of 22 breaths/minute

STI Infection Sites

Skin/mucosal lining of urethra, cervix, vagina, rectum, orpharynx

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply. Gallbladder disease Smoking Diabetes mellitus Physical inactivity Frequent upper respiratory infections

Smoking Diabetes mellitus Physical inactivity

gastric banding

a surgical means of producing weight loss by restricting stomach size with a constricting band

Hypertension

uIncreased risk of stroke, heart attack

physical inactivity

uSedentary lifestyle - Work environment, hobbies uLack of time for exercise uDecreased mobility due to prolonged illness - Ex: Back injury

Arterial Embolism and Arterial Thrombosis (Clots)

~Acute vascular occlusion may be caused by an embolus or acute thrombosis Pathophysiology ~ Aortic dissections (separations) are commonly associated with poorly controlled hypertension, blunt chest trauma, and cocaine use Clinical Manifestation ~Depends on size organ involvement, and state of collateral circulation ~ 6 P's- Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia (coldness), and Paralysis (not all have to be present) Assessment/Diagnostic ~Usually diagnosed on the basis of the sudden nature of the onset of symptoms and the apparent source of the embolus

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

diminished or absent breath sounds on the affected side.

Common Diets

fasting, very low calorie deficits, unbalanced lowe energy diets, nutritionally balanced diets, and novelty diets.

The classification of Stage II of COPD is defined as

moderate COPD.

Arterial blood gas analysis would reveal which value related to acute respiratory failure?

pH 7.28

The classification of Stage III of COPD is defined as

severe COPD.

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to:

sit upright, leaning slightly forward.

Patient colonized with Staphylococcus aurus may have...

staphylococci on skin without any skin interruption or irritation

waist circumference

u35 in women and > 40 in men = greater risk for obesity uHip to waist ratio

nutritionally balanced diets

uApproximately 1200 calories/day uRegular food, "lifestyle change", steady weight loss uExample: Weight Watchers

Osteoarthritis

uDegeneration of weight-bearing joints - Knees, hips, back

Diarrheal Causes

• Bacterial, campylobacter, salmonella, shigella, e.coli • viral, rotavirus and calicivirus (norovirus) • parasitic, giardia and cryptosporidium species and entamoeba hisolytica

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:

"Have you tried to quit smoking before?"

normal caloric intake for an infant

1,000 kcal

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of

2 to 12 days

normal caloric intake for an adult woman who is sedentary

2,000

normal caloric intake for a sedentary adult male

2,700

A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that:

A permanent tracheal stoma would be necessary.

A gerontologic nurse practitioner provides primary care for a large number of older adults who are living with various forms of cardiovascular disease. This nurse is well aware that heart disease is the leading cause of death in the aged. What is an age-related physiological change that contributes to this trend? A. Heart muscle and arteries lose their elasticity. B. Systolic blood pressure decreases. C. Resting heart rate decreases with age. D. Atrial-septal defects develop with age.

A. Heart muscle and arteries lose their elasticity. The leading cause of death for patients over the age of 65 years is cardiovascular disease. With age, heart muscle and arteries lose their elasticity, resulting in a reduced stroke volume. As a person ages, systolic blood pressure does not decrease, resting heart rate does not decrease, and the aged are not less likely to adopt a healthy lifestyle.

5. What portion of the nephron is involved with filtration? a. Glomerulus of the Bowman capsule b. Henle loop c. Proximal convoluted tubule d. Distal convoluted tubule

ANS: A Filtration of water and blood products occurs in the glomerulus of the Bowman capsule. PTS: 1 DIF: Cognitive Level: Application REF: Page 1673, Health Promotion OBJ: 8 TOP: Coping KEY: Nursing Process Step: Implementation

The nurse is caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids?

Noisy breathing

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?

Apply a tourniquet.

Which process of rheumatoid arthritis causes joint deformaty? A) Exacerbation B) Inflammation C) Remission

B) Inflammation

An occupational health nurse overhears an employee talking to his manager about a 65-year-old coworker. What phenomenon would the nurse identify when hearing the employee state, "He should just retire and make way for some new blood."? A. Intolerance B. Ageism C. Dependence D. Nonspecific prejudice

B. Ageism Ageism refers to prejudice against the aged. Intolerance is implied by the employee's statement, but the intolerance is aimed at the coworker's age. The employee's statement does not raise concern about dependence. The prejudice exhibited in the statement is very specific.

Pulmonary Embolism

Blood clot in the lungs ~Obstruction of the pulmonary artery or one of its branches Pathophysiology ~Most commonly it is due to a dislodged or fragmented DVT ~Occludes the outflow tract of the main pulmonary artery ~Impairs gas exchange! ~Hemodynamic instability (instability in the blood)- If sever, right ventricular failure occurs, which leads to hypotension, and shock

Raynaud's Phenomenon

Blanching and pain in fingers/extremities especially after exposure to cold

Colonization

Describes microorganisms present without host interference or interaction

The nurse is caring for a client status post adenoidectomy. The nurse finds the client in severe respiratory distress when entering the room. What does the nurse suspect?

Edema of the upper airway

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:

Elevate the affected area.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?

Elevate the affected extremity and use cold applications.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure?

Excision of damaged joint fibrocartilage

A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates?

Flail chest

The nurse has instructed a client on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which result?

Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing

Which measure may increase complications for a client with COPD?

Increased oxygen supply

A client's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? Drowsiness or lethargy Increased urine output Decreased heart rate Mild agitation

Increased urine output

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. decreases circulating blood volume.

Increases the heart rate, constricts arterioles, and reduces the heart's ability t eject blood.

Infections

Indicates host interaction with organism • Patient colonized with Staphylococcus aureus may have staphylococci on skin without any skin interruption or irritation

Which is the priority nursing diagnosis for a client undergoing a laryngectomy?

Ineffective airway clearance

A client reports nasal congestion, sneezing, sore throat, and coughing up of yellow mucus. The nurse assesses the client's temperature as 100.2°F. The client states this is the third episode this season. The highest priority nursing diagnosis is

Ineffective airway clearance related to excess mucus production

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be:

Ineffective airway clearance.

weight loss

Intake< energy used

Pulselessness, a very late sign of compartment syndrome, may signify

Lack of distal tissue perfusion

A nurse is weaning a client from mechanical ventilation. Which nursing assessment finding indicates the weaning process should be stopped?

Runs of ventricular tachycardia

The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%.

60 mm Hg; 90%

A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse? "Hypertension often causes no symptoms." "Hypertension often kills early in the disease process." "Hypertension often causes no pain." "Hypertension is difficult to diagnose."

"Hypertension often causes no symptoms."

A 73-year-old client is admitted to the pulmonology unit of the hospital. She was admitted with pleural effusion and was "tapped" to drain the fluid to reduce her mediastinal pressure. How much fluid is typically present between the pleurae, which surround the lungs, to prevent friction rub?

20 mL or less

According to the DASH diet, how many servings of vegetables should a person consume each day? 2 or fewer 2 or 3 4 or 5 7 or 8

4 or 5

Morton's neuroma is exhibited by which of the following clinical manifestations? a) Inflammation of the foot-supporting fascia b) High arm and a fixed equinus deformity c) Longitudinal arch of the foot is diminished d) Swelling of the third (lateral) branch of the median plantar nerve

Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton's neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.

A client has just been diagnosed with type 2 diabetes. The health care provider has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the health care provider prescribe for this client? A. A sulfonylurea B. A biguanide C. A thiazolidinedione D. An alpha-glucosidase inhibitor

B

A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary and secondary hypertension is what? Secondary hypertension has a specific cause. Secondary hypertension has a more gradual onset than primary hypertension. Secondary hypertension does not cause target organ damage. Secondary hypertension does not respond to antihypertensive drug therapy.

Secondary hypertension has a specific cause.

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?

Sharp and piercing

A client presents to the clinic reporting symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A. Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L) B. Random plasma glucose greater than 150 mg/dL (8.3 mmol/L) C. Fasting plasma glucose greater than 116 mg/dL (6.4 mmol/L) on two separate occasions D. Random plasma glucose greater than 126 mg/dL (7.0 mmol/L)

A

Which statement describes emphysema?

A disease of the airways characterized by destruction of the walls of overdistended alveoli

20. The patient is on postoperative day 1 after having undergone a TURP procedure. He has continuous bladder irrigation (CBI). Actual urine output during continuous bladder irrigation is calculated by: a. measuring and recording all fluid output in the drainage bag. b. measuring the total output and deducting the total of the irrigating and intravenous solutions. c. adding the total of the intravenous and irrigating solutions and then deducting the amount of output. d. measuring total output and deducting the amount of irrigating solution used.

ANS: D To determine urine output, the nurse will subtract the amount of irrigation fluid used with the Foley catheter output to calculate urine output. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation

A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group? Pacific Islanders African-Americans Asians Hispanics

African-Americans

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?

An inhaled beta2-adrenergic agonist

Anatomy and Function of the Vascular System

Anatomy ~Arteries, Arterioles, Capillaries, Veins, Venules, Lymphatic Vessels Function ~Circulatory needs of tissues ~Blood flow- One way system ~Blood pressure ~Peripheral vascular regulating mechanisms

The nurse is caring for a client with an endotracheal tube. Which client data does the nurse interpret as a life-threatening situation?

Sudden restlessness

A client with acute viral rhinosinusitis is being seen in a clinic. The nurse is providing discharge instructions and includes the following information:

Avoid air travel.

The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse.

Based on the nursing assessment, the priority action the nurse should take is to notify the orthopedic health care provider immediately and prepare the client for fasciotomy.

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Between 24 and 48 hours

The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective?

Classes at community centers to teach about smoking cessation strategies

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?

Dislocation of the hip

Lupus (Systemic Lupus Erythematosus)

Disorder characterized by autoimmune reaction in the body Females most at risk and between ages 15-40 Butterfly rash across cheeks and nose, red rash over light-exposed areas Alopecia Pleurisy (inflammation of lungs and surrounding tissue) Kidney involvement and depression

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC)

The nurse is planning an education program for women of childbearing years. The nurse recognizes that primary prevention of osteoporosis includes: a) Having a DXA beginning at age 35 years b) Engaging in non-weight-bearing exercises daily c) Undergoing assessment of serum calcium levels every year d) Ensuring adequate calcium and vitamin D intake

Ensuring adequate calcium and vitamin D intake Explanation: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.

The nurse assesses a client who is bleeding profusely from the nose. The nurse documents this finding as which condition?

Epistaxis

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client

Has wheezes in the right lung lobes

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client?

High-protein

The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?

Hypovolemic

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted?

I

nonsurgical management

Increase exercise, reduce caloric intake, drug therapy, acupuncture, hypnosis.

A client diagnosed with hypertension informs the nurse that they are not taking prescribed antihypertensive medications due to an absence of symptoms. What is the most appropriate response by the nurse? Inform the client that this is why hypertension is known as "the silent killer." Inform the client that remaining unmedicated is all right in conjunction with routine follow-up. Suggest that the client try an herbal supplement instead. Inform the client there should be no problems as long as she a low sodium diet is maintained.

Inform the client that this is why hypertension is known as "the silent killer."

Health History

Investigate likelihood & probable source of infection, associated pathology & symptoms

Duplex Ultrasonography

Involves B-mode grayscale imaging of the tissues, organs, and blood vessels (arterial and venous) and permits estimation of velocity changes by use of a pulsed doppler

A nurse is preparing to discharge a client from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage what action?

Keep an elastic compression bandage on the ankle.

anastomotic leak

Leak at suture line of stomach or intestine uMost common serious complication, cause of death after gastric bypass. uOlder, male, higher BMI, open procedure uIncreasing back, shoulder, abdominal pain, restlessness, unexplained tachycardia, and low urine output, fever, leukocytosis. uMay progress to sepsis/shock uReport finding to surgeon immediately. uDiagnose - CT ABD with contrast dye uTreatment - CT-guided drainage vs. immediate surgical intervention

OSHA

Mandatory regulations & guidelines

Vaccination Programs

More than 50 vaccines licensed in U.S. • MMR, varicella, influenze, HPV

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

Nonunion

Arteries

Oxygenated blood

Symptomology of rheumatic disease

Pain Joint swelling Limited movement Stiffness Weakness Fatigue

The nurse is preparing to perform tracheostomy care for a client with a newly inserted tracheostomy tube. Which action, if performed by the nurse, indicates the need for further review of the procedure?

Places clean tracheostomy ties then removes soiled ties after the new ties are in place without a second nurse assisting

Diarrheal Diseases

Port of entry is oral ingestion

sleeve gastrectomy

Portion of stomach is removed, leaving a banana-shaped stomach pouch.

A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together? Magnesium level Potassium level Calcium level Sodium level

Potassium level

A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? Hypertensive Normal Slightly hypertensive Prehypertensive

Prehypertensive

Which of the following positions should be avoided in severe back pain? a) Prone b) Supine c) Head and thorax elevated 30 degrees d) Lateral recumbent

Prone Explanation: A prone position should be avoided because it accentuates lordosis (inward curvature of the spine). Lumbar flexion is increased by elevating the head and thorax 30 degrees using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?

Providing sufficient oxygen to improve oxygenation

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? Purchasing a self-monitoring BP cuff Discussing methods for stress reduction Advising smoking cessation Administering glycemic control

Purchasing a self-monitoring BP cuff

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? a) plicamycin (Mithracin) b) methotrexate (Rheumatrex) c) penicillamine (Cuprimine) d) raloxifene (Evista)

Raloxifene (Evista) Explanation: Raloxifene (Evista) is used for the prevention and treatment of osteoporosis.

Physical Examination

Rashes, lesions, drainage, inguinal nodes, genitalia, rectal, mouth/throat; women need abdominal & uterine exam

Diarrhea History

Recent travel, use of antibiotics, food intake

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?

Respiratory acidosis

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis

Arteriosclerosis and Atherosclerosis Risk Factors and Preventions

Risk Factors ~Modifiable- Smoking (most important), Diabetes (increases overall risk of PAD), Hypertension, Hyperlipidemia, Diet, Stress, Sedentary lifestyle, Elevated C-reactive protein (can detect inflammation) ~Non-modifiable- Age, Genetics Preventions ~Diet- AHA recommends reduce the amount of fat in a diet, eat unsaturated fats rather than saturated fats, and decrease cholesterol intake ~Exercise ~Medications ~Decrease Hypertension ~Stop using tobacco products

Which term describes high blood pressure from an identified cause, such as renal disease? Primary hypertension Secondary hypertension Rebound hypertension Hypertensive emergency

Secondary hypertension

The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? Furosemide Spironolactone Chlorothiazide Chlorthalidone

Spironolactone

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as?

Sprain

STI Most Common

Syphilis, chlamydia trachomatis, neisseria, gonorrhea, HIV

Which is not a guideline for avoiding hip dislocation after replacement surgery.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) The recommended daily allowance of calcium may be found in a wide variety of foods. b) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. c) To prevent fractures, the client should avoid strenuous exercise. d) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.

The recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? The results will be falsely decreased. The results will be falsely elevated. It will give an accurate reading. It will be significantly different with each reading.

The results will be falsely elevated.

Which statement describes external fixation?

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

The system has an air leak.

A commonly prescribed methylxanthine used as a bronchodilator is which of the following?

Theophylline

Which type of ventilator has a preset volume of air to be delivered with each inspiration?

Volume-controlled

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles.

decreases the production of neurotransmitters that constrict peripheral arterioles.

Gout

Uric acid build up Primarily from diet

Which of the following is accurate regarding status asthmaticus?

A severe asthma episode that is refractory to initial therapy

A client is being seen by the physician because of an unrelenting headache, facial tenderness, low-grade fever, and dark yellow nasal discharge. The client reports seeming to develop sinus infections "all the time." Which factor may predispose the client to sinusitis?

interference with sinus drainage

gastric bypass

surgical treatment for obesity; portion of stomach is stapled off and bypassed so that it holds less food; also called stomach stapling

lifestyle modification

uAimed at weight loss and maintenance uSetting weight-loss goals uImproving diet habits uIncreasing physical activity uAddressing barriers to change uSelf-monitoring and strategizing ongoing lifestyle changes aimed at a healthy weight uHealth sleep habits

Postoperative care

uAssess to ensure goals for recovery are met uAssess for absence of complications uAnastomotic leak, DVT, bile reflux, Dumping Syndrome

A client has been brought to the emergency department by paramedics after being found unconscious. The client's MedicAlert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? A. IV administration of 50% dextrose in water B. Subcutaneous administration of 10 units of Humalog C. Subcutaneous administration of 12 to 15 units of regular insulin D. IV bolus of 5% dextrose in 0.45% NaCl

A

A client has been living with type 2 diabetes for several years, and the nurse realizes that the client is likely to have minimal contact with the health care system. In order to ensure that the client maintains adequate blood sugar control over the long term, what should the nurse recommend? A. Participation in a support group for persons with diabetes B. Regular consultation of websites that address diabetes management C. Weekly telephone "check-ins" with an endocrinologist D. Participation in clinical trials relating to antihyperglycemics

A

A diabetes nurse educator is teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client? A. Do not eliminate insulin when nauseated and vomiting. B. Report elevated glucose levels greater than 150 mg/dL (8.3 mmol/L). C. Eat three substantial meals a day, if possible. D. Reduce food intake and insulin doses in times of illness.

A

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what? A. "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." B. "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." C. "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." D. "I will call the doctor if my blood sugar is over 300 mg/dL (16.6 mmol/L) or if I have ketones in my urine."

A

A nurse is conducting a class on how to self-manage insulin regimens. A client asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer? A. "If you are going to use up the vial within 1 month, it can be kept at room temperature." B. "If a vial of insulin will be used up within 21 days, it may be kept at room temperature." C. "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature." D. "If a vial of insulin will be used up within 1 week, it may be kept at room temperature."

A

A nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A. Always carry a form of fast-acting sugar. B. Perform exercise prior to eating whenever possible. C. Eat a meal or snack every 8 hours. D. Check blood sugar at least every 24 hours.

A

A teenage client is brought to the emergency department with symptoms of hyperglycemia. Based on the fact that the pancreatic beta cells are being destroyed, the client would be diagnosed with what type of diabetes? A. Type 1 diabetes B. Type 2 diabetes C. Non-insulin-dependent diabetes D. Prediabetes

A

The most recent blood work of a client with a long-standing diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? A. Teach the client about actions to slow the progression of nephropathy. B. Ensure that the client receives a comprehensive assessment of liver function. C. Determine whether the client has been using expired insulin. D. Administer a fluid challenge and have the test repeated.

A

A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? A cuff that is too small will give a false high blood pressure. A cuff that is too small will give a false low blood pressure. A cuff that is too large will give a false high blood pressure. The size of the cuff does not matter as long as it fits snugly around the arm.

A cuff that is too small will give a false high blood pressure.

A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication?

0 to 4 mm

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client? ml

0.5 Explanation: 100 units x 1 ml/200 units = 0.5 ml.

High blood pressure is highly prevalent in the United States. Approximately how many people have high blood pressure in the United States? 1 in 3 adults 1 in 6 adults 1 in 7 adults 1 in 10 adults

1 in 3 adults

The client is to receive cephalexin (Ancef) 500 mg in 50 mL of normal saline intravenous piggyback. The medication is to infuse over 30 minutes. How many mL/hr would the nurse set the intravenous pump? Enter the correct number ONLY.

100

Biliopancreatic diversion with duodenal switch

80 percent of the stomach is removed, leaving a smaller tube-shaped stomach, similar to a banana. However, the valve that releases food to the small intestine (the pyloric valve) remains, along with a limited portion of the small intestine that normally connects to the stomach (duodenum). The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS both limits how much you can eat and reduces the absorption of nutrients, including proteins and fats.

A nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in a client with skeletal traction, what action should be included in the plan of care?

Assess the pin insertion site every 8 hours.

DVT Assessment/Prevention

Assessment ~Careful assessment, history collection, obesity, oral contraceptive use ~Ask about limb pain, feeling of heaviness, functional impairment, areas of tenderness ~Compare extremities Prevention ~Graduated compression stockings ~Use of intermittent pneumatic compression devices ~Early ambulation ~Leg exercises ~Administration of subcutaneous unfractionated heparin or low-molecular-weight heparin (LMWH) ~Weight loss ~Smoking cessation

The nurse is providing care for a client with a diagnosis of hypertension. The nurse should consequently assess the client for signs and symptoms of which other health problem? Migraines Atrial-septal defect Atherosclerosis Thrombocytopenia

Atherosclerosis

The nurse is caring for the client in the intensive care unit immediately after removal of the endotracheal tube. Which of the following nursing actions is most important to complete every hour to ensure that the respiratory system is not compromised?

Auscultate lung sounds.

A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned?

Auscultate the lung for adventitious sounds.

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?

Avascular necrosis may develop at the site if it is not promptly resolved.

11. What should the nurse encourage, barring any other contraindication, when teaching a patient how to decrease the chance of further problems with urolithiasis? a. Increase his fluid intake b. Increase intake of dairy products c. Restrict his protein intake d. Take one baby aspirin daily

ANS: A Fluid intake should be encouraged to at least 2000 mL of fluid in 24 hours, unless contraindicated. PTS: 1 DIF: Cognitive Level: Application REF: Page 1682 OBJ: 8 TOP: Urolithiasis KEY: Nursing Process Step: Implementation

34. What should the nurse counsel the young man with chronic prostatitis to avoid? a. Cessation of intercourse b. Warm baths c. Stool softeners d. Continuing antibiotics when symptoms abate

ANS: A Frequent intercourse may be beneficial to the treatment of chronic prostatitis. Warm baths, stool softeners, and antibiotic therapy are also part of the medical treatment. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1693 OBJ: 8 TOP: Urinalysis KEY: Nursing Process Step: Assessment

33. To help a patient control incontinence, what should the nurse recommend the patient avoid? a. Spicy foods b. Citrus fruits c. Organ meats d. Shellfish

ANS: A Incontinence may be improved by omitting spicy foods, alcohol, and caffeine from the diet. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1687 OBJ: 8 TOP: Incontinence KEY: Nursing Process Step: Implementation

14. The patient with nephrosis complains about the need for bed rest. How would the nurse explain the benefit of bed rest? a. The recumbent position may initiate diuresis. b. It preserves the skin integrity. c. It lowers the level of albuminuria. d. It saves stress on joints.

ANS: A It is believed that the recumbent position helps initiate diuresis. PTS: 1 DIF: Cognitive Level: Application REF: Page 1707 OBJ: 8 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation

21. A patient has nephrotic syndrome. Which statement made by the patient indicates understanding of the necessary diet modifications? a. "I will need to increase protein and decrease sodium intake." b. "I will need to drink more milk to get my calcium." c. "Carbohydrate restriction will be difficult." d. "Potassium restriction won't be hard since I don't like fruit."

ANS: A Medical management for nephrotic syndrome depends on the extent of tissue involvement and may include the use of corticosteroids and a low-sodium, high-protein diet. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1707 OBJ: 8 TOP: Nephrotic syndrome KEY: Nursing Process Step: Evaluation

24. An intravenous pyelogram confirms the presence of a 4-mm renal calculus in the proximal left ureter of a newly admitted patient. Physician orders include meperidine (Demerol) 100 mg IM q4h PRN, strain all urine, and encourage fluids to 4000 mL/day. What should be the nurse's highest priority when planning care for this patient? a. Pain related to irritation of a stone b. Anxiety related to unclear outcome of condition c. Ineffective health maintenance related to lack of knowledge about prevention of stones d. Risk for injury related to disorientation

ANS: A Nursing diagnoses directed at pain control are of primary importance at the early stages of care. Opioid medications manage the pain well. PTS: 1 DIF: Cognitive Level: Application REF: Page 1677 OBJ: 8 TOP: Renal calculi KEY: Nursing Process Step: Planning

7. The nurse is aware that as a person ages there is a loss of the mechanism of the kidney due to a decrease in blood supply to the kidneys and loss of nephrons. a. filtering b. reabsorption c. sterile water. d. concentrating

ANS: A The filtering mechanism is most affected with aging. By the age of 70, the filtering mechanism is only 50% as efficient as at 40 years of age. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1675 OBJ: 5 TOP: Effect of aging KEY: Nursing Process Step: Planning

3. Because the kidneys are located in proximity to the vertebrae and are protected by the ribs, their location in documentation is referred to as: a. retroperitoneal. b. diaphragm-vertebral. c. costovertebral. d. urachal-peritoneal.

ANS: A The kidneys lie behind the parietal peritoneum (retroperitoneal). PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1672 OBJ: 1 TOP: Location of kidneys KEY: Nursing Process Step: Assessment

16. The patient is scheduled for a transurethral resection of the prostate. During preoperative teaching, what should the nurse emphasize about what the patient can expect after the procedure? a. Red drainage from the catheter b. Limited intake of fluids c. A sodium-restricted diet d. Incisional drainage

ANS: A The patient and family need to know that hematuria is expected after prostatic surgery. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation

32. Which foods should the home health nurse counsel hypokalemic patients to include in their diet? a. Bananas, oranges, cantaloupe b. Carrots, summer squash, green beans c. Apples, pineapple, watermelon d. Winter squash, cauliflower, lettuce

ANS: A The use of most diuretics, with the exception of the potassium-sparing diuretics, requires adding daily potassium sources (e.g., baked potatoes, raw bananas, apricots, or navel oranges, cantaloupe, winter squash). PTS: 1 DIF: Cognitive Level: Application REF: Page 1681 OBJ: 7 TOP: Hypokalemia KEY: Nursing Process Step: Implementation

13. The nurse assessing a patient who is taking furosemide (Lasix) finds an irregular pulse. This is likely a sign of: a. hypomagnesemia. b. hypernatremia. c. hypokalemia. d. hypercalcemia.

ANS: C The loop diuretic prototype, furosemide (Lasix), affects electrolytes and causes hypokalemia; the deficiency of the electrolyte can cause arrhythmias and muscle weakness. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680 OBJ: 7 TOP: Medications KEY: Nursing Process Step: Assessment

Which of the following clients with type 1 diabetes is most likely to experience adequate glucose control? A. A client who skips breakfast when the glucose reading is greater than 220 mg/dL (12.3 mmol/L) B. A client who never deviates from the prescribed dose of insulin C. A client who adheres closely to a meal plan and meal schedule D. A client who eliminates carbohydrates from the daily intake

C

A class of nursing students is in their first semester of nursing school. The instructor explains that one of the changes they will undergo while in nursing school is learning to "think like a nurse." What is the most current model of this thinking process? A. Critical-thinking Model B. Nursing Process Model C. Clinical Judgment Model D. Active Practice Model

C. Clinical Judgment Model To depict the process of "thinking like a nurse," Tanner (2006) developed a model known as the clinical judgment model.

In the process of planning a patient's care, the nurse has identified a nursing diagnosis of Ineffective Health Maintenance related to alcohol use. What must precede the determination of this nursing diagnosis? A. Establishment of a plan to address the underlying problem B. Assigning a positive value to each consequence of the diagnosis C. Collecting and analyzing data that corroborates the diagnosis D. Evaluating the patient's chances of recovery

C. Collecting and analyzing data that corroborates the diagnosis In the diagnostic phase of the nursing process, the patient's nursing problems are defined through analysis of patient data. Establishing a plan comes after collecting and analyzing data; evaluating a plan is the last step of the nursing process and assigning a positive value to each consequence is not done.

You are the nurse caring for patients in the urology clinic. A new patient, 78 years old, presents with complaints of urinary incontinence. An anticholinergic is prescribed. Why might this type of medication be an inappropriate choice in the elderly population? A. Gastrointestinal hypermotility can be an adverse effect of this medication. B. Detrusor instability can be an adverse effect of this medication. C. Confusion can be an adverse effect of this medication. D. Increased symptoms of urge incontinence can be an adverse effect of this medication.

C. Confusion can be an adverse effect of this medication. Although medications such as anticholinergics may decrease some of the symptoms of urge incontinence (detrusor instability), the adverse effects of these medications (dry mouth, slowed gastrointestinal motility, and confusion) may make them inappropriate choices for the elderly.

An 84-year-old patient has returned from the post-anesthetic care unit (PACU) following hip arthroplasty. The patient is oriented to name only. The patient's family is very upset because, before having surgery, the patient had no cognitive deficits. The patient is subsequently diagnosed with postoperative delirium. What should the nurse explain to the patient's family? A. This problem is self-limiting and there is nothing to worry about. B. Delirium involves a progressive decline in memory loss and overall cognitive function. C. Delirium of this type is treatable and her cognition will return to previous levels. D. This problem can be resolved by administering antidotes to the anesthetic that was used in surgery.

C. Delirium of this type is treatable and her cognition will return to previous levels. Surgery is a common cause of delirium in older adults. Delirium differs from other types of dementia in that delirium begins with confusion and progresses to disorientation. It has symptoms that are reversible with treatment, and, with treatment, is short term in nature. It is patronizing and inaccurate to reassure the family that there is "nothing to worry about." The problem is not treated by the administration of antidotes to anesthetic.

As the population of the United States ages, research has shown that this aging will occur across all racial and ethnic groups. A community health nurse is planning an initiative that will focus on the group in which the aging population is expected to rise the fastest. What group should the nurse identify? A. Asian-Americans B. White non-Hispanics C. Hispanics D. African-Americans

C. Hispanics Although the older population will increase in number for all racial and ethnic groups, the rate of growth is projected to be fastest in the Hispanic population that is expected to increase from 6 million in 2004 to an estimated 17.5 million by 2050.

A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform? A. Instruct the patient to drink 1 liter of water before the test. B. Administer IV benzodiazepines and opioids. C. Inform the patient that she will remain on bed rest following the procedure. D. Inform the patient that an access line will be initiated in her femoral artery.

C. Inform the patient that she will remain on bed rest following the procedure. During the recovery period, the patient must maintain bed rest with the head of the bed elevated to 45 degrees. The patient must be NPO 6 hours preprocedure. The patient is sedated to make him or her comfortable, but will not be heavily sedated, and opioids are not necessary. Also, the patient will have a peripheral IV line initiated preprocedure.

The care team has deemed the occasional use of restraints necessary in the care of a patient with Alzheimer's disease. What ethical violation is most often posed when using restraints in a long-term care setting? A. It limits the patient's personal safety. B. It exacerbates the patient's disease process. C. It threatens the patient's autonomy. D. It is not normally legal.

C. It threatens the patient's autonomy. Because safety risks are involved when using restraints on elderly confused patients, this is a common ethical problem, especially in long-term care settings. By definition, restraints limit the individual's autonomy. Restraints are not without risks, but they should not normally limit a patient's safety. Restraints will not affect the course of the patient's underlying disease process, though they may exacerbate confusion. The use of restraints is closely legislated, but they are not illegal.

A client with type 2 diabetes has been managing his blood glucose levels using diet and metformin. Following an ordered increase in the client's daily dose of metformin, the nurse should prioritize which of the following assessments? A. Monitoring the client's neutrophil levels B. Assessing the client for signs of impaired liver function C. Monitoring the client's level of consciousness and behavior D. Reviewing the client's creatinine and BUN levels

D

A diabetes nurse educator is presenting current recommendations for levels of caloric intake. What are the current recommendations that the nurse would describe? A. 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein B. 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C. 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein D. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

D

A medical nurse is aware of the need to screen specific clients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what client population does this syndrome most often occur? A. Clients who are obese and who have no known history of diabetes B. Clients with type 1 diabetes and poor dietary control C. Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D. Middle-aged or older people with either type 2 diabetes or no known history of diabetes

D

A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy? A. Persistently cold feet B. Pain that does not respond to analgesia C. Acute pain, unrelieved by rest D. The presence of a tingling sensation

D

A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. What topic should the nurse address? A. Signs and symptoms of diabetic nephropathy B. Management of diabetic ketoacidosis C. Effects of surgery and pregnancy on blood sugar levels D. Recognition of hypoglycemia and hyperglycemia

D

A school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes? A. Have blood glucose levels checked annually. B. Stop using tobacco in any form. C. Undergo eye examinations regularly. D. Lose weight, if obese.

D

An older adult client with type 2 diabetes is brought to the emergency department by the client's daughter. The client is found to have a blood glucose level of 600 mg/dL (33.3 mmol/L). The client's daughter reports that the client recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A. Administration of antihypertensive medications B. Administering sodium bicarbonate intravenously C. Reversing acidosis by administering insulin D. Fluid and electrolyte replacement

D

25. A physician explains to the patient that he has an inflammation of the Cowper glands. Where are the Cowper glands located? A) Within the epididymis B) Below the prostate, within the posterior aspect of the urethra C) On the inner epithelium lining the scrotum, lateral to the testes D) Medial to the vas deferens

B Feedback: Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.

A client newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline should the nurse teach the clients at this class? A. Low fat generally indicates low sugar. B. Protein should constitute 30% to 40% of caloric intake. C. Most calories should be derived from carbohydrates. D. Animal fats should be eliminated from the diet.

C

A client with type 1 diabetes has told the nurse that the client's most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? A. The client should withhold the next scheduled dose of insulin. B. The client should promptly eat some protein and carbohydrates. C. The client's insulin levels are inadequate. D. The client would benefit from a dose of metformin.

C

A client with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client? A. Examine feet weekly for redness, blisters, and abrasions. B. Avoid the use of moisturizing lotions. C. Avoid hot-water bottles and heating pads. D. Dry feet vigorously after each bath.

C

A diabetes educator is teaching a client about type 2 diabetes. The educator recognizes that the client understands the primary treatment for type 2 diabetes when the client states: A. "I read that a pancreas transplant will provide a cure for my diabetes." B. "I will take my oral antidiabetic agents when my morning blood sugar is high." C. "I will make sure to follow the weight loss plan designed by the dietitian." D. "I will make sure I call the diabetes educator when I have questions about my insulin."

C

A nurse is providing health education to a teenage client newly diagnosed with type 1 diabetes mellitus, as well as the client's family. The nurse teaches the client and family nonpharmacologic measures that will decrease the body's need for insulin. What measure provides the greatest impact on glucose reduction? A. Adequate sleep B. Low stimulation C. Exercise D. Low-fat diet

C

A pregnant client has been diagnosed with gestational diabetes. The client is shocked by the diagnosis, stating that they are conscientious about their health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A. Increased caloric intake during the first trimester B. Changes in osmolality and fluid balance C. The effects of hormonal changes during pregnancy D. Overconsumption of carbohydrates during the first two trimesters

C

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

C

The health care provider has explained to a client that the client has developed diabetic neuropathy in the right foot. Later that day, the client asks the nurse what causes diabetic neuropathy. What would be the nurse's best response? A. "Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years." B. "The cause is not known for sure but it is thought to have something to do with ketoacidosis." C. "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." D. "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose and ketone levels."

C

33. A 57-year-old male comes to the clinic complaining that when he has an erection his penis curves and becomes painful. The patient's diagnosis is identified as severe Peyronie's disease. The nurse should be aware of what likely treatment modality? A) Physical therapy B) Treatment with PDE-5 inhibitors C) Intracapsular hydrocortisone injections D) Surgery

D Feedback: Surgical removal of mature plaques is used to treat severe Peyronie's disease. There is no potential benefit to physical therapy and hydrocortisone injections are not normally used. PDE-5 inhibitors would exacerbate the problem.

6. A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A) It is most common among men over 55. B) It is one of the least curable solid tumors. C) It typically does not metastasize. D) It is highly responsive to treatment.

D Feedback: Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less To stop smoking and increase physical activity to 30 minutes/day most days of the week To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less

A client newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the client and advises that the client should avoid tobacco use. What is the primary rationale behind that advice to the client? Quitting smoking will cause the client's hypertension to resolve. Tobacco use increases the client's concurrent risk of heart disease. Tobacco use is associated with a sedentary lifestyle. Tobacco use causes ventricular hypertrophy.

Tobacco use increases the client's concurrent risk of heart disease.

The nurse is caring for a client in the physician's office with a potential sinus infection. The physician orders a diagnostic test to identify if fluid is found in the sinus cavity. Which diagnostic test, written by the physician, is specifically ordered for this purpose?

Transillumination of the sinus

A client has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the client has done which of the following? Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Drank adequate fluids during the day prior Avoided drinking coffee for 12 hours before the visit

Tried o rest quietly for 5 minutes before the reading is taken

A patient has come to the clinic for a follow-up assessment. Before taking the blood pressure, the nurse should determine if the patient has: Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Been NPO for at least 2 hours Avoided drinking coffee for 12 hours before the visit

Tried to rest quietly for 5 minutes before the reading is taken

Is the following statement true or false? Droplet precautions include wearing a face mask, but the door may remain open; transmission is limited to close contact.

True. Droplet precautions include wearing a face mask, but the door may remain open; transmission is limited to close contact. Airborne precautions are for patients with presumed or proven airborne pathogens. These patients must be in airborne infection isolation rooms, engineered to provide negative air pressure, rapid turnover of air, and air either highly filtered or exhausted directly to the outside.

Is the following statemnt true or false? The CDC is a federal agency responsible for monitoring endemic and epidemic disease, recommending strategies to decrease disease incidence, and developing guidelines to reduce risk to patients and health care workers.

True. The CDC is a federal agency responsible for monitoring endemic and epidemic disease, recommending strategies to decrease disease incidence, and developing guidelines to reduce risk to patients and health care workers. The WHO and CDC are the principal agencies involved in setting guidelines about infection prevention.

Leg Ulcers Medical/Nursing Management

Medical ~Pharmacologic therapy ~Compression therapy ~Cleansing and debridement ~Topical therapy ~Wound dressing ~Stimulated healing such as Hyperbaric Oxygenation, Magot Therapy, Negative Pressure Wound Healing (wound vac- increases circulation) Nursing ~Assessment of skin/wound/pain ~Diagnosis ~Planning and goals ~Nursing interventions- Positinoning of the leg depends on if it is venous or arterial ~Activity/walking ~Restoring skin integrity ~Improving mobility ~!!!Promoting nutrition- High in protein (building blocks help heal), Vitamin C and A, Iron, Zinc

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders? a) Osteoporosis b) Osteomalacia c) Osteitis deformans d) Osteomyelitis

Osteitis deformans Explanation: Osteitis deformans (Paget's disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from the extension of a soft tissue infection, direct bone contamination, or hematogenous spread.

fasting

Not proven to be successful for morbid obesity, most regain any weight lost. Risks: Severe ketoacidosis

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse?

Notify the health care provider.

Oral Rehydration

ORS solution

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture?

Open reduction

The nurse recognizes that goal of treatment for metastatic bone cancer is to: a) Diagnose the extent of bone damage b) Promote pain relief and quality of life c) Cure the diseased bone and cartilage d) Reconstruct the bone with a prosthesis

Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative.

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? a) Raloxifene b) Fosamax c) Denosumab d) Forteo

Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures.

The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS?

Rapid onset of severe dyspnea

A nurse has pharyngitis and will be providing self care at home. It is most important for the nurse to

Seek medical help if he experiences inability to swallow

A nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply.

Take a slow, deep inhalation from the device. The device may increase delivery of the MDI medication. Activate the MDI once

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?

Take ordered medications as scheduled.

An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. What should the nurse include in health education? Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker Maintaining a diet high in dairy to increase protein necessary to prevent organ damage Use of strategies to prevent falls stemming from postural hypotension Limiting exercise to avoid injury that can be caused by increased intracranial pressure

Use of strategies to prevent falls stemming from postural hypotension

An older male client with a history of chronic laryngitis reports a persistent hoarseness. What condition is the client at risk to develop?

laryngeal cancer

The nurse is caring for a client following a tonsillectomy and adenoidectomy. Two hours after the procedure, the client begins to vomit large amounts of dark blood at frequent intervals and is tachycardic and febrile. After notifying the surgeon, the nurse

obtains a light, mirror, gauze, and curved hemostats.

A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as

pleural effusion.

The nurse is providing discharge instructions for a client following laryngeal surgery. The nurse instructs the client to avoid

swimming.

medications for obesity

uAntiobesity medication meant to supplement not supplant diet modification and exercise uIndications: u BMI >30 u BMI >27 with related concomitant morbidity uActions: uInhibit gastrointestinal absorption of fats - Ex: Orlistat uAltering central noradrenergic receptors causing appetite suppression- Ex: Phentermine

collaborative problems and potential complications

uChange in bowel habits, including diarrhea and/or constipation uHemorrhage uVenous thromboembolism uBile reflux uDumping syndrome uDysphagia uBowel or gastric outlet obstruction uAnastomotic leak

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he:

uses the sternocleidomastoid muscles.

The classification of Stage IV of COPD is defined as

very severe COPD.

weight gain

weight gain = intake > energy used

Choice Multiple question - Select all answer choices that apply. Which of the following are clinical manifestations of impingement syndrome? Select all that apply. a) Pain b) Limited movement c) Shoulder tenderness d) Muscle spasms e) Atrophy

• Pain • Shoulder tenderness • Limited movement • Muscle spasms • Atrophy Explanation: The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear

Five P's

• Partners • Prevention of pregnancy • Protection from STIs • Practices • Past history of STIs

Increasing Adherence

• Patient education in group or individualized settings • Appropriate agencies referral

Reduction of risk to household members

• Prevent of transmission • Education • Fever/comfort

Infectious Disease Planning/Goals

• Prevent spread • Increased knowledge about infection & treatment • control fever & related discomforts • complication absence

Infectious Disease Nursing Interventions

• Preventing spread • Education about infectious process & prevention of spread • assessment & treatment of fever & accompanying discomforts • monitoring & managing potential complications

STI Patient Assessment

• Protect confidentiality • Communication needs to be culturally/emotionally sensitive & clarivication of terms • Physical examination

Infectious Disease Home-Based Care

• Reduction of risk to patients • Reduction of risk to household members

STI Nursing Interventions

• STD & infection spread education • Reducing anxiety • increasing adherence

Infectious Disease Problems/Complications

• Septicemia, bacteremia, sepsis • septic shock • dehydration • abscess formation • endocarditis • infectious disease-related cancers • infertility • congenital abnormalities

Severe Dehydration

• Signs of shock (i.e., rapid thready pulse, cyanosis, cold extremities, rapid breathing, lethargy, coma) • IV replacement until hemodynamic & mental status return to normal then treat with ORS

Contact Precautions

• Skin-to-skin contact; antibiotic-resistant organisms or clostridium difficile • Barrier use prevents transmission; Mask not needed; emphasize cautious technique

Moderate Dehydration

• Sunken eyes, loss of skin turgor, increased thirst, and dry oral mucous membranes • Rehydration goal 100 mL/kg of ORS over 4 hours

Airborne Precautions

• TB, varicella, other airborne pathogens • Hospitalized PT should be in - pressure room with door closed; HC providers should wear N-95 respirator mask at all times in room

Infection Control and Prevention

• World Health Organization (WHO) • Centers for Disease Control and Prevention (CDC) • Occupational Safety and Health Administration (OSHA) • Local angencies • Hospital.facility infection control specalists & facility policies

STI Problems/Complications

• ectopic pregnancy • infertility • transmission of infection to fetus • neurosyphilis • gonococcal meningitis • gonococcal arthritis • syphilitic aortitis • HIV-related complications

Patient/Family Education

• establish environment that facilitates hand hygiene & aseptic technique • family caregivers should recieve annual influenza vaccine • equipment care • "common-sense-cleanliness" • establishment of reasonable barriers to protect family members

Standard Precaution Elements

• hand hygiene • use of gloves / other barriers • proper handling of patient care equipment/linen • environmental control • injury prevention from sharp devices/needles • patient placement

Preventing Spread of Infection

• handwashing • standard precautions • recognition of mode of transmission and establishment of transmission-based precautions as indicated

STI Goals/Planning

• increased patient understanding of natural hisotry/treatment • anxiety reduction • increased compliance with therapeutic/preventive goals • complication absence

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse?

"CPM increases range of motion of the joint."

A 56-year-old male client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" What is the nurse's best response? "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." "You have no need to worry. Your pressure is probably elevated because you are being tested."

"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made."

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client? "Take this medication before going to bed." "Increase the amount of fruits and vegetables you eat." "You may develop nasal congestion or depression while taking this medication." "You may drink alcohol while taking this medication."

"Increase the amount of fruits and vegetables you eat."

A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing. Place the steps in order in which the nurse will instruct the client.

"Inhale through your nose." "Slowly count to 3." "Exhale slowly through pursed lips." "Slowly count to 7."

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care?

"Keep your right leg elevated above heart level."

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "A glass of red wine each day will lower my blood pressure." "I should eliminate caffeine from my diet to lower my blood pressure." "If I include less fat in my diet, I'll lower my blood pressure." "Limiting my salt intake to 2 grams per day will improve my blood pressure."

"Limiting my salt intake to 2 grams per day will improve my blood pressure."

A client is being evaluated for possible lung cancer. Which client statement most likely indicates lung cancer?

"My cough has changed from a dry cough to one with lots of sputum production."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What client education should the nurse provide to this client? "Eat a banana every day because this medication causes moderate hyperkalemia." "Take over-the-counter potassium pills because this medication causes your kidneys to lose potassium." "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." "This medication increases sodium levels in your blood, so cut down on your salt."

"This medication can cause low blood pressure and dizziness, especially when you get up suddenly."

A client with newly diagnosed hypertension has come to the clinic for a follow-up visit. The client asks the nurse why she has to come in so often. What would be the nurse's best response? "We do this so we can identify any of the early symptoms of a stroke." "We do this to determine how your blood pressure changes throughout the day." "We do this to see how often you should change your medication dose." "We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."

"We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."

A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care?

"You must consume a diet rich in protein, such as chicken, fish, and beans."

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

- Allowing the client to express grief - Encouraging the client to care for the residual limb - Introducing the client to local amputee support groups

A 13-year-old soccer player presents to the emergency room with a fractured nose. The patient's mother is given which of the following post-discharge instructions? Select all that apply.

- Check for any unusual changes in breathing during the first 48 hours. - Observe for any clear drainage from either nostril. - Elevate the head of the bed for sleeping during the first week. - Restrict from sports activities for 6 weeks.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.)

- Excruciating pain - Decreased sensory function - Loss of motion

An older adult client experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply.

- Loss of visual acuity - Muscle weakness - Adverse medication effects - Slowed reflexes

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

- wound infection - skin breakdown - pneumonia

Varicose Vains

Abnormally dilated, tortuous, superficial veins called by incompetent venous valves Pathophysiology ~Reflux of venous blood results in venous stasis Manifestations ~Dull aches, Muscle cramps, increased muscle fatigue in the lower legs, ankle edema, and a feeling of heaviness of the legs ~Nocturnal cramps common ~May develop s/sx of chronic venous insufficiency Assessment ~Duplex ultrasound

A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing what health problem? Acute kidney injury Right ventricular hypertrophy Glaucoma Anemia

Acute kidney injury

A homeless client with streptococcal pharyngitis is being seen in a clinic. The nurse is concerned that the client will not continue treatment after leaving the clinic. Which of the following measures is the highest priority?

Administer one intramuscular injection of penicillin.

Which action should the nurse take first when providing care for a client during an acute asthma attack?

Administer prescribed short-acting bronchodilator.

A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs?

Administer the salmeterol and then administer the triamcinolone.

In which statements regarding medications taken by a client diagnosed with COPD do the drug name and the drug category correctly match? Select all that apply.

Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.

A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take?

Assesses fasting blood glucose levels

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply.

Atelectasis Respiratory failure Status asthmaticus

Types of Rheumatic diseases

Autoimmune Degenerative - Osteoarthritis Systemic - Lupus Inflammatory - Rheumatoid Arthritis

Health Care-Associated Bloodstream Infection

CLABSI

The nurse is developing a nursing care plan for a client who is being treated for hypertension. What is a measurable client outcome that the nurse should include? Client will reduce Na+ intake to no more than 2.4 g daily. Client will have a stable BUN and serum creatinine levels. Client will abstain from fat intake and reduce calorie intake. Client will maintain a normal body weight.

Client will reduce Na+ intake to no more than 2.4 g daily.

Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years? a) Increased heel pain b) Bone spurs c) Diarrhea d) Decreased height

Decreased height Explanation: Clients with osteoporosis become shorter over time.

Which term refers to a fracture in which one side of a bone is broken and the other side is bent?

Greenstick

A patient comes to the clinic with complaints of a sore throat and is diagnosed with acute pharyngitis. What does the nurse understand is the cause of acute pharyngitis?

Group A, beta-hemolytic streptococci

Infectious Disease

Infected host displaces decline in wellness caused by infections

Infectious Diarrhea Nursing Interventions

• Oral rehydration • Mild dehydration • Moderate dehydration • Severe dehydration • Increasing knowledge/preventing spread

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a) Thoracic b) Lower lumbar c) Upper lumbar d) Cervical

Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.

Arterial Embolism and Arterial Thrombosis (Clots) Medical/Nursing Managements

Medical ~Depends on the cause ~Heparin ~Endovascular management ~Pharmacologic therapy Nursing ~Bed rest with affected extremity level or slightly elevated ~Vital signs, continuous monitoring, monitor for hemorrhage ~Post op care ~TPA- Clot buster (time frame to use)

Meds for Rheumatic diseases

NSAIDs DMARDs - Hydrochloroquine (esp for Lupus) Corticosteroids Immunosuppressants Immunomodulators

Which test best determines Systemic Lupus Erythermatosus (SLE)?

No one single test will diagnose Accumulation of S/S, blood and urine tests, and physical examination

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments?

Oxygen through nasal cannula at 2 L/minute

What kind of rheumatic disease is Lupus?

Systemic

The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient?

The patient is hypoxic from suctioning.

The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education?

The patient should take the medication an hour before meals or 2 hours after a meal.

morbid disease and disorders with obesity

alzheimers, sleep apnea, thyroid cancer, CAD, renal cancer, type II diabetes mellitus, osteoarthritis etc.

american women vs. american men

american woman are susceptible to being obese.

lab studies

cholesterol, triglycerides, fasting blood glucose, HA1c, liver function tests

The classification of grade I COPD is defined as

mild COPD.

malabsorption surgery

uExample: Roux-en-Y Gastric Bypass uStomach, duodenum, and portion of jejunum bypassed = Less calories absorbed uRapid weight loss uHigh risk for post-operative complications, nutritional deficits, anastomotic leaks.

Emerging Infectious Disease

• COVID-19 • Zike Virus • West Nile viruse • Ebola viral disease • Legionnaires disease • Pertussis

The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching? Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.

Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.

Isolation Precations

Guidlines prevent transmission of microorganisms in hospitals • Standard • Transmission-based

Which of the following was formerly called a bunion? a) Hallux valgus b) Plantar fasciitis c) Morton's neuroma d) Ganglion

Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

Preventing Community-Aquired Infections

• Collaborative effort of CDC, state, local public health departments • Methods • Vaccination programs

Mild Dehydration

• Dry oral mucous membranes of mouth & increased thirst • Rehydration goal 50 mL/kg per 1 kg ORS over 4 hours

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? a) "After menopause, the body's bone density declines, resulting in a gradual loss of height." b) "There may be some slight discrepancy between the measuring tools used." c) "The posture begins to stoop after middle age." d) "After age 40, height may show a gradual decrease as a result of spinal compression"

"After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? "Your blood pressure is fine. Just keep doing what you're doing." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."

"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue?

"Delay self-care activities for 1 hour."

A client exhibits a sudden and complete loss of voice and is coughing. The nurse states

"Do not smoke and avoid being around others who are smoking."

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "Using arm splints will prevent hyperflexion of the wrist." b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." c) "Surgery is the only sure way to manage this condition." d) "This condition is associated with various sports."

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family?

"Family members should continue to talk to the client."

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction?

"I can't use a spacer or holding chamber with the MDI."

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary?

"I do not need to rinse my mouth with this type of inhaler."

The nurse is obtaining a health history from a client with laryngitis. Which causative factor, stated by the client, is least likely?

"I was chewing ice chips all day long."

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? a) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." b) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." c) "Bunions are congenital and can't be prevented." d) "Bunions are caused by a metabolic condition called gout."

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.

The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for:

Symmetry of the client's chest expansion

Reducing anxiety

• Encourage anxiety/fear discussion • Provide factual information/individualized education • Planning discussion with partners assistance • Social worker/specialists referral

Reduction of risk to patients

• Equipment care • Patient education

19. A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B) HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C) Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D) Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.

A Feedback: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.

31. A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? A) Closely monitoring the input and output of the bladder irrigation system B) Administering parenteral nutrition and fluids as ordered C) Monitoring the patient's level of consciousness and skin turgor D) Scanning the patient's bladder for retention every 2 hours

A Feedback: Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

13. A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens? A) Continuous inflow and outflow of irrigation solution B) Intermittent inflow and continuous outflow of irrigation solution C) Continuous inflow and intermittent outflow of irrigation solution D) Intermittent flow of irrigation solution and prevention of hemorrhage

A Feedback: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

24. A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this patient's concern? A) Inform the patient that urinary control is likely to return gradually. B) Arrange for the patient to be assessed by his urologist. C) Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D) Teach the patient to perform intermittent self-catheterization.

A Feedback: It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

32. A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time? A) Provide empathy and encouragement in an effort to foster a positive outlook. B) Tell the patient it is his decision whether to accept or reject chemotherapy. C) Report the patient's statement to members of his support system. D) Refer the patient to social work.

A Feedback: Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the patient's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the patient's statement to members of his support system and there is no obvious need for a social work referral.

34. A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? A) Pelvic floor exercises B) Intermittent urinary catheterization C) Reduced physical activity D) Active range of motion exercises

A Feedback: Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

16. A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem? A) Chronic bacterial prostatitis B) Orchitis C) Benign prostatic hyperplasia D) Urolithiasis

A Feedback: Prostatitis is an inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. Urinary incontinence and retention occur with benign prostatic hyperplasia or hypertrophy. The patient may experience nocturia, urgency, decrease in volume and force of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not cause urinary symptoms.

Infectious Diarrhea Planning/Goals

• Fluid/electrolyte balance maintenance • Increase knowledge about disease/risk for transmission • Complication absence

17. To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what? A) Report the planned use of dietary supplements to the physician. B) Decrease the intake of fluids to prevent urinary retention. C) Abstain from sexual activity for 2 weeks following the initiation of treatment. D) Anticipate a temporary worsening of urinary retention before symptoms subside.

A Feedback: Some herbal supplements are contraindicated with Proscar, thus their planned use should be discussed with the physician or pharmacist. The patient should maintain normal fluid intake. There is no need to abstain from sexual activity and a worsening of urinary retention is not anticipated.

12. A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? A) Testicular cancer is a highly curable type of cancer. B) Testicular cancer is very difficult to diagnose. C) Testicular cancer is the number one cause of cancer deaths in males. D) Testicular cancer is more common in older men.

A Feedback: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.

11. A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.

A Feedback: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

30. A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the patient's subsequent care? A) Disturbed Body Image Related to Effects of Surgery B) Spiritual Distress Related to Effects of Cancer Surgery C) Social Isolation Related to Effects of Surgery D) Risk for Loneliness Related to Change in Self-Concept

A Feedback: The patient's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This patient is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the patient's concerns.

Increasing Knowledge & Preventing Spread of Infection

• Food preparation • Hygiene • Standard precautions

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a client with hypertension, the nurse learns that the client has a family history of hypertension and she herself has high cholesterol and lipid levels. The client says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk factor for hypertension? Hyperlipidemia Excessive alcohol intake A family history of hypertension Closer adherence to medical regimen

A family history of hypertension

38. The nurse is leading a workshop on sexual health for men. The nurse should teach participants that organic causes of erectile dysfunction include what? Select all that apply. A) Diabetes B) Testosterone deficiency C) Anxiety D) Depression E) Parkinsonism

A,B,E Feedback: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.

22. A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply. A) Phimosis B) Priapism C) Herpes simplex infection D) Increasing age E) Lack of circumcision

A,D,E Feedback: Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of age), lichen sclerosus, and balanitis xerotica obliterans. Priapism and HSV are not known risk factors.

What is colonization? A. Describes microorganisms present without host interference or interaction B. Indicates host interaction with the organism C. The infected host displays a decline in wellness caused by the infection D. Organisms that have been recently acquired and are likely to be shed in a relatively short period of time

A. Colonization describes microorganisms present without host interference or interaction. Infection indicates host interaction with th eorganism. Disease indicates the infected host displaying a decline in wellness caused by the infection. Transient flora are organisms that have been recently acquired and are liekly to be shed in a relatively short period of time.

The nurse caring for a patient who is two days post hip replacement notifies the physician that the patient's incision is red around the edges, warm to the touch, and seeping a white liquid with a foul odor. What type of problem is the nurse dealing with? A. Collaborative problem B. Nursing problem C. Medical problem D. Administrative problem

A. Collaborative Problem In addition to nursing diagnoses and their related nursing interventions, nursing practice involves certain situations and interventions that do not fall within the definition of nursing diagnoses. These activities pertain to potential problems or complications that are medical in origin and require collaborative interventions with the physician and other members of the health care team. The other answers are incorrect because the signs and symptoms of infection are a medical complication that requires interventions by the nurse.

You are the nurse caring for an 85-year-old patient who has been hospitalized for a fractured radius. The patient's daughter has accompanied the patient to the hospital and asks you what her father can do for his very dry skin, which has become susceptible to cracking and shearing. What would be your best response? A. "He should likely take showers rather than baths, if possible." B. "Make sure that he applies sunscreen each morning." C. "Dry skin is an age-related change that is largely inevitable." D. "Try to help your father increase his intake of dairy products."

A. "He should likely take showers rather than baths, if possible." Showers are less drying than hot tub baths. Sun exposure should indeed be limited, but daily application of sunscreen is not necessary for many patients. Dry skin is an age-related change, but this does not mean that no appropriate interventions exist to address it. Dairy intake is unrelated

The nurse is conducting patient teaching about cholesterol levels. When discussing the patient's elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what? A. "Increased LDL and decreased HDL increase my risk of coronary artery disease." B. "Increased LDL has the potential to decrease my risk of heart disease." C. "The decreased HDL level will increase the amount of cholesterol moved away from the artery walls." D. "The increased LDL will decrease the amount of cholesterol deposited on the artery walls."

A. "Increased LDL and decreased HDL increase my risk of coronary artery disease." Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.

The nurse is caring for a 65-year-old patient who has previously been diagnosed with hypertension. Which of the following blood pressure readings represents the threshold between high-normal blood pressure and hypertension? A. 140/90 mm Hg B. 145/95 mm Hg C. 150/100 mm Hg D. 160/100 mm Hg

A. 140/90 mm Hg Hypertension is the diagnosis given when the blood pressure is greater than 140/90 mm Hg. This makes the other options incorrect

The nurse is calculating a cardiac patient's pulse pressure. If the patient's blood pressure is 122/76 mm Hg, what is the patient's pulse pressure? A. 46 mm Hg B. 99 mm Hg C. 198 mm Hg D. 76 mm Hg

A. 46 mm Hg Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg.

A nurse uses critical thinking every day when going through the nursing process. Which of the following is an outcome of critical thinking in nursing practice? A. A comprehensive plan of care with a high potential for success B. Identification of the nurse's preferred goals for the patient C. A collaborative basis for assigning care D. Increased cost efficiency in health care

A. A comprehensive plan of care with a high potential for success Critical thinking in nursing practice results in a comprehensive plan of care with maximized potential for success. Critical thinking does not identify the nurse's goal for the patient or provide a collaborative basis for assigning care. Critical thinking may or may not lead to increased cost efficiency; the patient's outcomes are paramount.

A nurse is caring for an 86-year-old female patient who has become increasingly frail and unsteady on her feet. During the assessment, the patient indicates that she has fallen three times in the month, though she has not yet suffered an injury. The nurse should take action in the knowledge that this patient is at a high risk for what health problem? A. A hip fracture B. A femoral fracture C. Pelvic dysplasia D. Tearing of a meniscus or bursa

A. A hip fracture The most common fracture resulting from a fall is a fractured hip resulting from osteoporosis and the condition or situation that produced the fall. The other listed injuries are possible, but less likely than a hip fracture.

You are providing care for a patient who has a diagnosis of pneumonia attributed to Streptococcus pneumonia infection. Which of the following aspects of nursing care would constitute part of the planning phase of the nursing process? A. Achieve SaO2 > 92% at all times. B. Auscultate chest q4h. C. Administer oral fluids q1h and PRN. D. Avoid overexertion at all times.

A. Achieve SaO2 > 92% at all times. The planning phase entails specifying the immediate, intermediate, and long-term goals of nursing action, such as maintaining a certain level of oxygen saturation in a patient with pneumonia. Providing fluids and avoiding overexertion are parts of the implementation phase of the nursing process. Chest auscultation is an assessment.

A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Of what age-related change should the nurse be aware when planning the appropriate administration of this drug? A. An older patient has less subcutaneous tissue and less muscle mass than a younger patient. B. An older patient has more subcutaneous tissue and less durable skin than a younger patient. C. An older patient has more superficial and tortuous nerve distribution than a younger patient. D. An older patient has a higher risk of bleeding after an IM injection than a younger patient.

A. An older patient has less subcutaneous tissue and less muscle mass than a younger patient. When administering IM injections, the nurse should remember that in an older patient, subcutaneous fat diminishes, particularly in the extremities. Muscle mass also decreases. There are no significant differences in nerve distribution or bleeding risk.

While receiving report on a group of patients, the nurse learns that a patient with terminal cancer has granted power of attorney for health care to her brother. How does this affect the course of the patient's care? A. Another individual has been identified to make decisions on behalf of the patient. B. There are binding parameters for care even if the patient changes her mind. C. The named individual is in charge of the patient's finances. D. There is a document delegating custody of children to other than her spouse.

A. Another individual has been identified to make decisions on behalf of the patient. A power of attorney is said to be in effect when a patient has identified another individual to make decisions on her behalf. The patient has the right to change her mind. A power-of-attorney for health care does not give anyone the right to make financial decisions for the patient nor does it delegate custody of minor children.

The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patient's stroke volume. The nurse recognizes that afterload is increased when there is what? A. Arterial vasoconstriction B. Venous vasoconstriction C. Arterial vasodilation D. Venous vasodilation

A. Arterial vasoconstriction Arterial vasoconstriction increases the systemic vascular resistance, which increases the afterload. Venous vasoconstriction decreases preload thereby decreasing stroke volume. Venous vasodilation increases preload.

Achieving adequate pain management for a postoperative patient will require sophisticated critical thinking skills by the nurse. What are the potential benefits of critical thinking in nursing? Select all that apply. A. Enhancing the nurse's clinical decision making B. Identifying the patient's individual preferences C. Planning the best nursing actions to assist the patient D. Increasing the accuracy of the nurse's judgments E. Helping identify the patient's priority needs

A. Enhancing the nurse's clinical decision making C. Planning the best nursing actions to assist the patient D. Increasing the accuracy of the nurse's judgments E. Helping identify the patient's priority needs Independent judgments and decisions evolve from a sound knowledge base and the ability to synthesize information within the context in which it is presented. Critical thinking enhances clinical decision making, helping to identify patient needs and the best nursing actions that will assist patients in meeting those needs. Critical thinking does not normally focus on identify patient desires; these would be identified by asking the patient.

You are writing a care plan for an 85-year-old patient who has community-acquired pneumonia and you note decreased breath sounds to bilateral lung bases on auscultation. What is the most appropriate nursing diagnosis for this patient? A. Ineffective airway clearance related to tracheobronchial secretions B. Pneumonia related to progression of disease process C. Poor ventilation related to acute lung infection D. Immobility related to fatigue

A. Ineffective airway clearance related to tracheobronchial secretions Nursing diagnoses are not medical diagnoses or treatments. The most appropriate nursing diagnosis for this patient is "ineffective airway clearance related to copious tracheobronchial secretions." "Pneumonia" and "poor ventilation" are not nursing diagnoses. Immobility is likely, but is less directly related to the patient's admitting medical diagnosis and the nurse's assessment

An emergency department nurse is caring for a 7-year-old child suspected of having meningitis. The patient is to have a lumbar puncture performed, and the nurse is doing preprocedure teaching with the child and the mother. The nurse's action is an example of which therapeutic communication technique? A. Informing B. Suggesting C. Expectation-setting D. Enlightening

A. Informing Informing involves providing information to the patient regarding his or her care. Suggesting is the presentation of an alternative idea for the patient's consideration relative to problem solving. This action is not characterized as expectation-setting or enlightening.

A medical nurse has obtained a new patient's health history and completed the admission assessment. The nurse has followed this by documenting the results and creating a care plan for the patient. Which of the following is the most important rationale for documenting the patient's care? A. It provides continuity of care. B. It creates a teaching log for the family. C. It verifies appropriate staffing levels. D. It keeps the patient fully informed.

A. It provides continuity of care This record provides a means of communication among members of the health care team and facilitates coordinated planning and continuity of care. It serves as the legal and business record for a health care agency and for the professional staff members who are responsible for the patient's care. Documentation is not primarily a teaching log; it does not verify staffing; and it is not intended to provide the patient with information about treatments.

An elderly patient, while being seen in an urgent care facility for a possible respiratory infection, asks the nurse if Medicare is going to cover the cost of the visit. What information can the nurse give the patient to help allay her concerns? A. Medicare has a copayment for many of the services it covers. This requires the patient to pay a part of the bill. B. Medicare pays for 100% of the cost for acute-care services, so the cost of the visit will be covered. C. Medicare will only pay the cost for acute-care services if the patient has a very low income. D. Medicare will not pay for the cost of acute-care services so the patient will be billed for the services provided.

A. Medicare has a copayment for many of the services it covers. This requires the patient to pay a part of the bill. The two major programs that finance health in the United States are Medicare and Medicaid, both of which are overseen by the Centers for Medicaid and Medicare Services (CMS). Both programs cover acute-care needs such as inpatient hospitalization, physician care, outpatient care, home health services, and skilled nursing care in a nursing. Medicare is a plan specifically for the elderly population, and Medicaid is a program that provides services based on income.

Falls, which are a major health problem in the elderly population, occur from multifactorial causes. When implementing a comprehensive plan to reduce the incidence of falls on a geriatric unit, what risk factors should nurses identify? Select all that apply. A. Medication effects B. Overdependence on assistive devices C. Poor lighting D. Sensory impairment E. Ineffective use of coping strategies

A. Medication effects C. Poor lighting D. Sensory impairment Causes of falls are multifactorial. Both extrinsic factors, such as changes in the environment or poor lighting, and intrinsic factors, such as physical illness, neurologic changes, or sensory impairment, play a role. Mobility difficulties, medication effects, foot problems or unsafe footwear, postural hypotension, visual problems, and tripping hazards are common, treatable causes. Overdependence on assistive devices and ineffective use of coping strategies have not been shown to be factors in the rate of falls in the elderly population.

The physician has placed a central venous pressure (CVP) monitoring line in an acutely ill patient so right ventricular function and venous blood return can be closely monitored. The results show decreased CVP. What does this indicate? A. Possible hypovolemia B. Possible myocardial infarction (MI) C. Left sided heart failure D. Aortic valve regurgitation

A. Possible hypovolemia Hypovolemia may cause a decreased CVP. MI, valve regurgitation and heart failure are less likely causes of decreased CVP.

Based on a patient's vague explanations for recurring injuries, the nurse suspects that a community-dwelling older adult may be the victim of abuse. What is the nurse's primary responsibility? A. Report the findings to adult protective services. B. Confront the suspected perpetrator. C. Gather evidence to corroborate the abuse. D. Work with the family to promote healthy conflict resolution.

A. Report the findings to adult protective services. If neglect or abuse of any kind—including physical, emotional, sexual, or financial abuse—is suspected, the local adult protective services agency must be notified. The responsibility of the nurse is to report the suspected abuse, not to prove it, confront the suspected perpetrator, or work with the family to promote resolution.

Your older adult patient has a diagnosis of rheumatoid arthritis (RA) and has been achieving only modest relief of her symptoms with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When creating this patient's plan of care, which nursing diagnosis would most likely be appropriate? A. Self-care deficit related to fatigue and joint stiffness B. Ineffective airway clearance related to chronic pain C. Risk for hopelessness related to body image disturbance D. Anxiety related to chronic joint pain

A. Self-care deficit related to fatigue and joint stiffness Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions. Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessness are plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely. Ineffective airway clearance is unlikely.

For several years, a community health nurse has been working with a 78-year-old man who requires a wheelchair for mobility. The nurse is aware that the interactions between disabilities and aging are not yet clearly understood. This interaction varies, depending on what variable? A. Socioeconomics B. Ethnicity C. Education D. Pharmacotherapy

A. Socioeconomics Large gaps exist in our understanding of the interaction between disabilities and aging, including how this interaction varies, depending on the type and degree of disability, and other factors such as socioeconomics and gender. Ethnicity, education, and pharmacotherapy are not identified as salient influences on this interaction.

A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what? A. Systole B. Diastole C. Repolarization D. Ejection fraction

A. Systole Systole is the action of the chambers of the heart becoming smaller and ejecting blood. This action of the heart is not diastole (relaxations), ejection fraction (the amount of blood expelled), or repolarization (electrical charging).

A group of students have been challenged to prioritize ethical practice when working with a marginalized population. How should the students best understand the concept of ethics? A. The formal, systematic study of moral beliefs B. The informal study of patterns of ideal behavior C. The adherence to culturally rooted, behavioral norms D. The adherence to informal personal values

A. The formal, systematic study of moral beliefs In essence, ethics is the formal, systematic study of moral beliefs, whereas morality is the adherence to informal personal values.

You are the nurse who is caring for a patient with a newly diagnosed allergy to peanuts. Which of the following is an immediate goal that is most relevant to a nursing diagnosis of "deficient knowledge related to appropriate use of an EpiPen"? A. The patient will demonstrate correct injection technique with today's teaching session. B. The patient will closely observe the nurse demonstrating the injection. C. The nurse will teach the patient's family member to administer the injection. D. The patient will return to the clinic within 2 weeks to demonstrate the injection.

A. The patient will demonstrate correct injection technique with today's teaching session. Immediate goals are those that can be reached in a short period of time. An appropriate immediate goal for this patient is that the patient will demonstrate correct administration of the medication today. The goal should specify that the patient administer the EpiPen. A 2-week time frame is inconsistent with an immediate goal.

The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems? A. To assess the patient's response to fluid and drug administration B. To obtain specimens for arterial blood gas measurements C. To dislodge pulmonary emboli D. To diagnose the etiology of chronic obstructive pulmonary disease

A. To assess the patient's response to fluid and drug administration Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the patient's response to medical interventions, such as fluid administration and vasoactive medications. Pulmonary artery monitoring is preferred for the patient with heart failure over central venous pressure monitoring. Arterial catheters are useful when arterial blood gas measurements and blood samples need to be obtained frequently. Neither intervention is used to clear pulmonary emboli.

You have just taken report for your shift and you are doing your initial assessment of your patients. One of your patients asks you if an error has been made in her medication. You know that an incident report was filed yesterday after a nurse inadvertently missed a scheduled dose of the patient's antibiotic. Which of the following principles would apply if you give an accurate response? A. Veracity B. Confidentiality C. Respect D. Justice

A. Veracity The obligation to tell the truth and not deceive others is termed veracity. The other answers are incorrect because they are not obligations to tell the truth.

44. In the nephrotic syndrome, the glomeruli are damaged by inflammation and allow small to pass through into the urine.

ANS: proteins In nephrotic syndrome, the glomeruli are damaged by inflammation and allow small proteins such as albumin to enter the urine. This creates a deficit of protein in the circulation volume (hypoalbuminemia), which leads to massive edema. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1707 OBJ: 8 TOP: Nephrotic syndrome KEY: Nursing Process Step: Assessment

40. is a term for severe generalized edema.

ANS: Anasarca The patient with nephritic syndrome has severe generalized edema (anasarca), anorexia, fatigue, and impaired renal function. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1707 OBJ: 8 TOP: Key term KEY: Nursing Process Step: Assessment

45. Put the sequence of blood flow in order of flow through the nephron. (Separate letters by a comma and space as follows: A, B, C, D) a. Reabsorption in loop of Henle b. Efferent arteriole c. Filtration in the glomerulus d. Reabsorption in proximal convoluted tubule e. Afferent arteriole f. Secretion in the distal convoluted tubule

ANS: E, C, D, A, F, B The blood enters the nephron via the afferent arteriole, is filtered through the glomerulus, reabsorption occurs in the proximal convoluted tubule, then the loop of Henle, then the distal convoluted tubule, and then out the efferent arteriole. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1673, Figure 49-3 OBJ: 2 TOP: Nephron action KEY: Nursing Process Step: Assessment

39. Exercises to increase muscle tone of the pelvic floor are known as exercises.

ANS: Kegel Women with weakened structures of the pelvic floor are prone to stress incontinence. For the female patient, Kegel exercises are helpful; 10 repetitions, 5 to 10 times a day, are suggested to improve muscle tone. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1685 OBJ: 8 TOP: Kegel exercises KEY: Nursing Process Step: Assessment

41. Acute glomerulonephritis is commonly a result of a preexisting infection of .

ANS: beta-hemolytic streptococci The health history commonly reveals that the onset of acute glomerulonephritis is preceded by beta-hemolytic streptococcal infection. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1708 OBJ: 8 TOP: Acute glomerulonephritis KEY: Nursing Process Step: Assessment

36. Why are urinary tract infections (UTI) common in older adults? (Select all that apply.) a. Older adults have weakened musculature in the bladder and urethra. b. Older adults have urinary stasis. c. Older adults have increased bladder capacity. d. Older adults have diminished neurologic sensation. e. The effects of medications such as diuretics that many older adults take.

ANS: A, B, D, E Urinary frequency, urgency, nocturia, retention, and incontinence are common with aging. These occur because of weakened musculature in the bladder and urethra, diminished neurologic sensation combined with decreased bladder capacity, and the effects of medications such as diuretics. Older women are at risk for stress incontinence because of hormonal changes and weakened pelvic musculature. Inadequate fluid intake (less than 1000 to 2000 mL per 24 hours) can lead to urinary stasis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1675, Lifespan OBJ: 8 TOP: Urinary frequency KEY: Nursing Process Step: Assessment

35. The nurse reassures the patient recovering from acute glomerulonephritis that after all other signs and symptoms of the disease subside, it is normal to have some residual (select all that apply): a. proteinuria b. oliguria c. hematuria d. anasarca e. oliguria

ANS: A, C Proteinuria and hematuria may exist microscopically even when other symptoms subside. PTS: 1 DIF: Cognitive Level: Application REF: Page 1709 OBJ: 8 TOP: Acute glomerulonephritis KEY: Nursing Process Step: Implementation

38. The nurse is reviewing the urinalysis report on an assigned patient. The nurse recognizes which findings to be normal? (Select all that apply.) a. Turbidity clear b. pH 6.0 c. Glucose negative d. Red blood cells, 15 to 20 e. White blood cells

ANS: A, C The type and size of urinary catheter are determined by the location and cause of the urinary tract problem. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1676, Table 49-2 OBJ: 4 TOP: Urinalysis KEY: Nursing Process Step: Assessment

23. The patient has end-stage renal disease (ESRD) and is admitted to the hospital with a blood urea nitrogen (BUN) level of 48 mg/dL. An excessive elevation of BUN could result from: a. dehydration. b. disorientation. c. edema. d. catabolism.

ANS: B If the BUN is elevated, preventive nursing measures should be instituted to protect the patient from possible disorientation or seizures. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1711 OBJ: 8 TOP: ESRD KEY: Nursing Process Step: Assessment

4. A home health patient with end-stage renal disease (ESRD) has a nursing diagnosis of powerlessness related to life-altering disease. Which nursing intervention would be most helpful? a. Ensure restricted protein intake to prevent nitrogenous product accumulation. b. Include the patient in making the plan of care. c. Counsel patient about end-of-life provisions. d. Write out a detailed schedule of physician's appointments.

ANS: B Listen to the patient and allow time for discussion about concerns and the plan of care to return some sense of control. End-of-life discussions are premature. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1713, Nursing Care Plan OBJ: 12 TOP: ESRD KEY: Nursing Process Step: Planning

31. Why are pediatric patients, especially girls, susceptible to urinary tract infections? a. Genetically females have a weaker immune system b. Females have a short and proximal urethra in relation to the vagina c. Girls are more sexually active than males d. Girls have a weakened musculature and sphincter tone

ANS: B Pediatric patients, especially girls, are susceptible to urinary tract infections because of the short urethra. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1691 OBJ: 1 TOP: Urinary anatomy KEY: Nursing Process Step: Assessment

26. A patient with cystitis is receiving phenazopyridine (Pyridium) for pain and is voiding a bright red-orange urine. What should the nurse do? a. Report this immediately b. Explain to the patient that this is normal c. Increase fluid intake d. Collect a specimen

ANS: B Pyridium will turn the urine reddish-orange. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680, Table 49-3 OBJ: 7 TOP: Cystitis KEY: Nursing Process Step: Implementation

18. A patient, age 69, is admitted to the hospital with gross hematuria and history of a 20-lb weight loss during the last 3 months. The physician suspects renal cancer. In obtaining a nursing history from this patient, the nurse recognizes which of the following as a significant risk factor for renal cancer? a. High caffeine intake b. Cigarette smoking c. Use of artificial sweeteners d. Chronic cystitis

ANS: B Risk factors include smoking; familial incidence; and preexisting renal disorders, such as adult polycystic kidney disease and renal cystic disease secondary to renal failure. PTS: 1 DIF: Cognitive Level: Application REF: Page 1698 OBJ: 8 TOP: Renal cancer KEY: Nursing Process Step: Assessment

6. When the home health patient is started on dialysis, the home health nurse refers the patient to a community support group that assists with the adjustments necessary to living with dialysis. Which group offers this service? a. National Kidney Foundation b. American Association of Kidney Patients c. American Red Cross d. Veterans Administration

ANS: B The American Association of Kidney Patients offer support to the patient and family as they adapt to living with dialysis. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1518 OBJ: 11 TOP: Community resources KEY: Nursing Process Step: Planning

27. The patient, age 43, has cancer of the urinary bladder. He has received a cystectomy with an ileal conduit. Which characteristics would be considered normal for his urine? a. Hematuria b. Clear amber with mucus shreds c. Dark bile-colored d. Dark amber

ANS: B There will be mucus present in the urine from the intestinal secretions. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1720 OBJ: 6 TOP: Ileal conduit KEY: Nursing Process Step: Assessment

15. What should the nurse instruct the patient to do before obtaining the urine specimen for a urine culture? a. Collect the urine for a 24-hour period b. Obtain a clean-catch specimen c. Bring in an early morning specimen d. Limit fluid intake to concentrate the urine

ANS: B Urine cultures are dependent on a clean-catch or catheterized specimen. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1691 OBJ: 8 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation

1. What is the hormone from the posterior pituitary gland that influences the amount of water that is eliminated with the urine? a. Pitocin b. Renin hormone c. Antidiuretic hormone (ADH) d. ACTH

ANS: C ADH causes the cells of the distal convoluted tubules to increase their rate of water reabsorption. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1674 OBJ: 3 TOP: Urine production KEY: Nursing Process Step: Assessment

17. A male patient, age 71, has benign prostatic hypertrophy. He is recovering from a trans-urethral prostatic resection. The physician orders removal of the indwelling catheter 2 days after the TURP procedure. What might the patient experience after the catheter is removed? a. Burning on urination b. Passing of blood clots in the urine c. Dribbling of urine d. Coffee-colored urine

ANS: C The patient is informed that initially he may experience frequency and voiding small amounts with some dribbling. There should be no hematuria or clots after 2 days. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation

22. What should the patient be encouraged to eat during the active phase of acute renal failure? a. A diet high in sodium b. A diet high in potassium c. A diet high in fats d. A diet high in fluid sources

ANS: C The patient with acute glomerulonephritis would need a high carbohydrate, high fat diet to maintain weight. Potassium and sodium are restricted as well as excess fluids. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1708 OBJ: 9 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation

25. A patient is receiving chlorothiazide (Diuril), a thiazide diuretic for hypertension. What nursing action is most important for prevention of complications? a. Measure output b. Increase fluid intake c. Assess for hypokalemia d. Assess for hypernatremia

ANS: C The thiazide diuretic, chlorothiazide (Diuril), affects electrolytes to cause hypokalemia (extreme potassium depletion in blood). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680 OBJ: 7 TOP: Medications KEY: Nursing Process Step: Planning

12. The nurse notes the amount and color of the urine the patient with urolithiasis has voided. While using Standard Precautions, what should be the nurse's next action? a. Discard the urine b. Add the urine to a 24-hour collector c. Send the urine to the laboratory d. Strain the urine

ANS: D All urine should be strained. Because stones may be any size, even the smallest speck must be saved for assessment by the laboratory. PTS: 1 DIF: Cognitive Level: Application REF: Page 1697 OBJ: 8 TOP: Urolithiasis KEY: Nursing Process Step: Planning

2. As the body breaks down protein, nitrogen wastes are broken down into urea, ammonia, and: a. nitrogen. b. uric acid. c. nitrates. d. creatinine.

ANS: D As proteins break down, nitrogenous wastes—urea, ammonia, and creatinine—are produced. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1671 OBJ: 4 TOP: Physiology KEY: Nursing Process Step: Assessment

29. The home health nurse suggests the use of complementary and alternative therapies to prevent and/or treat urinary tract infections (UTIs). Which of the following is an example of such therapies? a. Grape juice b. Caffeine c. Tea d. Cranberry juice

ANS: D Cranberry (Cranberry Plus, Ultra Cranberry) has been used to prevent urinary tract infections (UTIs), particularly in women prone to recurrent infection. It has also been used to treat acute UTI. Monitor patients for lack of therapeutic effect. Caffeine and tea will increase diuresis but not prevent UTI. PTS: 1 DIF: Cognitive Level: Application REF: Page 1689, Complementary and Alternative Therapy OBJ: 7 TOP: Complementary and alternative therapy KEY: Nursing Process Step: Assessment

30. Which action can reduce the risk of skin impairment secondary to urinary incontinence? a. Decreasing fluid intake b. Catheterization of the elderly patient c. Limiting the use of medication (diuretics, etc.) d. Frequent toileting and meticulous skin care

ANS: D Frequent toileting of the incontinent patient will prevent retained moisture in undergarments and bed linens and will preserve the integrity of the skin. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1676, Lifespan OBJ: 8 TOP: Urinary frequency KEY: Nursing Process Step: Assessment

19. As the nurse and the dietitian review a female patient's diet plan with her, she shouts that with her diabetes and now the kidney failure, there is just nothing she can eat. She says she might as well eat what she wants, because there is nothing she can do to help herself. Based on the patient's response, which nursing diagnosis does the nurse identify? a. Noncompliance, risk for, related to feelings of anger b. Imbalanced nutrition less than body requirements, related to knowledge deficit c. Anticipatory grieving, related to actual and perceived losses d. Ineffective coping, related to sense of powerlessness

ANS: D Ineffective coping due to the feeling of powerlessness against the multiorgan failure may result in aggressive or infantile behavior. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1712-1713, Nursing Care Plan OBJ: 12 TOP: Coping KEY: Nursing Process Step: Planning

10. It is 2 days after a 42-year-old male patient's urinary diversion surgery. He continues to be critical of the hospital and the nursing care, even though the staff has spent time explaining the care to him. What is the most likely explanation for his behavior? a. He is angry about hospital policy. b. He is feeling neglected by the nursing staff. c. He is in denial of the effects of the surgery. d. He is reacting to the loss of self-esteem and altered body image.

ANS: D Persons with altered body image may react to the loss of self-esteem by behaving in a critical or derogatory manner. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1675 OBJ: 10 TOP: Coping KEY: Nursing Process Step: Assessment

8. A patient who is receiving continuous bladder irrigation following a transurethral resection of the prostate (TURP) complains of "spasm-like" pain over his lower abdomen. What should the initial intervention be by the nurse? a. Inform the nurse in charge b. Decrease the continuous bladder irrigation flow c. Administer the prescribed analgesic d. Check the catheter and drainage system for obstruction

ANS: D The patient who has a TURP may have continuous closed bladder irrigation or intermittent irrigation to prevent occlusion of the catheter with blood clots, which would cause bladder spasms. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation

28. A patient, age 78, has been admitted to the hospital with dehydration and electrolyte imbalance. She is confused and incontinent of urine on admission. Which nursing intervention does the nurse include in developing a plan of care? a. Restrict fluids after the evening meal b. Insert an indwelling catheter c. Assist the patient to the bathroom every 2 hours d. Apply absorbent incontinence pads

ANS: D Use of protective undergarments may help to keep the patient and the patient's clothing dry. Confused patients are high risk for falls. Restricting fluids will only decrease incontinence during the night and will exacerbate the dehydration and electrolyte imbalance. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1689 OBJ: 8 TOP: Incontinence KEY: Nursing Process Step: Implementation

The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following?

Acute respiratory distress syndrome

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? Age Obesity Inactivity Dyslipidemia

Age

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

Albuterol

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What drug would the nurse know to administer to the client?

Albuterol

Which is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)?

Amoxicillin

The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first?

An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office

A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection?

An antiviral agent such as acyclovir

Raynaud's Disease Medical/Nursing Management

Medical ~Protect from cold and other triggers (tobacco) ~Avoid injury to hands and fingers -won't be able to heal Nursing ~Avoid stress ~Layer clothing ~Wear gloves during the cold

12. A patients current antiretroviral regimen includes nucleoside reverse transcriptase inhibitors (NRTIs). What dietary counseling will the nurse provide based on the patients medication regimen? A) Avoid high-fat meals while taking this medication. B) Limit fluid intake to 2 liters a day. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 698 C) Limit sodium intake to 2 grams per day. D) Take this medication without regard to meals.

Ans: D Feedback: Many NRTIs exist, but all of them may be safely taken without regard to meals. Protein, fluid, and sodium restrictions play no role in relation to these drugs.

5. A hospital patient is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test? A) Arrange for a portable x-ray machine to be used. B) Have the patient wear a mask to the x-ray department. C) Ensure that the radiology department has been disinfected prior to the test. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 695 D) Send the patient to the x-ray department, and have the staff in the department wear masks.

Ans: A Feedback: A patient who is immunocompromised is at an increased risk of contracting nosocomial infections due to suppressed immunity. The safest way the test can be facilitated is to have a portable x-ray machine in the patients room. This confers more protection than disinfecting the radiology department or using masks.

17. A patient with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? A) Administer antidiarrheal medications on a scheduled basis, as ordered. B) Encourage the patient to eat three balanced meals and a snack at bedtime. C) Increase the patients oral fluid intake. D) Encourage the patient to increase his or her activity level.

Ans: A Feedback: Administering antidiarrheal agents on a regular schedule may be more beneficial than administering them on an as-needed basis, provided the patients diarrhea is not caused by an infectious microorganism. Increased oral fluid may exacerbate diarrhea; IV fluid replacement is often indicated. Small, more frequent meals may be beneficial, and it is unrealistic to increase activity while the patient has frequent diarrhea.

8. A nurse is planning the care of a patient with AIDS who is admitted to the unit withPneumocystis pneumonia (PCP). Which nursing diagnosis has the highest priority for this patient? A) Ineffective Airway Clearance B) Impaired Oral Mucous Membranes C) Imbalanced Nutrition: Less than Body Requirements D) Activity Intolerance

Ans: A Feedback: Although all these nursing diagnoses are appropriate for a patient with AIDS, Ineffective Airway Clearance is the priority nursing diagnosis for the patient with Pneumocystis pneumonia (PCP). Airway and breathing take top priority over the other listed concerns.

Home-Based Care Measures Infection Risk Reduction

• HC workers should follow standard precautions in home setting • Patient/family education

19. A patient with HIV has a nursing diagnosis of Risk for Impaired Skin Integrity. What nursing intervention best addresses this risk? Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 701 A) Utilize a pressure-reducing mattress. B) Limit the patients physical activity. C) Apply antibiotic ointment to dependent skin surfaces. D) Avoid contact with synthetic fabrics.

Ans: A Feedback: Devices such as alternating-pressure mattresses and low-air-loss beds are used to prevent skin breakdown. Activity should be promoted, not limited, and contact with synthetic fabrics does not necessary threaten skin integrity. Antibiotic ointments are not normally used unless there is a break in the skin surface.

1. Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. Members of what group currently have the greatest risk of contracting HIV? A) Gay, bisexual, and other men who have sex with men B) Recreational drug users C) Blood transfusion recipients D) Health care providers

Ans: A Feedback: Gay, bisexual, and other men who have sex with men remain the population most affected by HIV and account for 2% of the population but 61% of the new infections. This exceeds the incidence among drug users, health care workers, and transfusion recipients.

2. A clinic nurse is caring for a patient admitted with AIDS. The nurse has assessed that the patient is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what complication? A) HIV encephalopathy B) B-cell lymphoma C) Kaposis sarcoma D) Wasting syndrome

Ans: A Feedback: HIV encephalopathy is a clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions. The other listed complications do not normally have cognitive and behavioral manifestations.

30. An HIV-infected patient presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/mL, and the nurse recognizes the patients increased risk for Mycobacterium aviumcomplex (MAC disease). The nurse should anticipate the administration of what drug? A) Azithromycin B) Vancomycin C) Levofloxacin D) Fluconazole Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 706

Ans: A Feedback: HIV-infected adults and adolescents should receive chemoprophylaxis against disseminatedMycobacterium avium complex (MAC disease) if they have a CD4+ count less than 50 cells/L. Azithromycin (Zithromax) or clarithromycin (Biaxin) are the preferred prophylactic agents. Vancomycin, levofloxacin, and fluconazole are not prophylactic agents for MAC.

38. A patient who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? A) Teach the patient guided imagery. B) Give the patient more control of her antiretroviral regimen. C) Increase the patients activity level. D) Collaborate with the patients physician to obtain an order for hydromorphone.

Ans: A Feedback: Measures such as relaxation and guided imagery may be beneficial because they decrease anxiety, which contributes to weakness and fatigue. Increased activity may be of benefit, but for other patients this may exacerbate feelings of anxiety or loss. Granting the patient control has the potential to reduce anxiety, but the patient is not normally given unilateral control of the ART regimen. Hydromorphone is not used to treat anxiety.

34. A nurse is assessing the skin integrity of a patient who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces? A) Perianal region and oral mucosa B) Sacral region and lower abdomen C) Scalp and skin over the scapulae D) Axillae and upper thorax

Ans: A Feedback: The nurse should inspect all the patients skin surfaces and mucous membranes, but the oral mucosa and perianal region are particularly vulnerable to skin breakdown and fungal infection. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 708

16. The nurses plan of care for a patient with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to Candidiasis. What nursing intervention best addresses this risk? A) Providing thorough oral care before and after meals B) Administering prophylactic antibiotics C) Promoting nutrition and adequate fluid intake D) Applying skin emollients as needed

Ans: A Feedback: Thorough mouth care has the potential to prevent or limit the severity of this infection. Antibiotics are Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 700 irrelevant because of the fungal etiology. The patient requires adequate food and fluids, but these do not necessarily prevent candidiasis. Skin emollients are not appropriate because candidiasis is usually oral.

40. A nurse is performing the admission assessment of a patient who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply. A) Current medication regimen B) Identification of patients support system C) Immune system function D) Genetic risk factors for HIV E) History of sexual practices

Ans: A, B, C, E Feedback: Nursing assessment includes numerous focuses, including identification of medication use, support system, immune function and sexual history. HIV does not have a genetic component.

33. A nurse is completing a nutritional status of a patient who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply. A) Serum albumin level B) Weight history C) White blood cell count D) Body mass index E) Blood urea nitrogen (BUN) level

Ans: A, B, D, E Feedback: Nutritional status is assessed by obtaining a dietary history and identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing. In addition, the patients ability to purchase and prepare food is assessed. Weight history (i.e., changes over time); anthropometric measurements; and blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status. White cell count is not a typical component of a nutritional assessment.

A client comes to the emergency department and reports localized pain and swelling in the lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. What will the nurse most likely suspect?

Contusion

27. A patient is beginning an antiretroviral drug regimen shortly after being diagnosed with HIV. What nursing action is most likely to increase the likelihood of successful therapy? A) Promoting appropriate use of complementary therapies B) Addressing possible barriers to adherence C) Educating the patient about the pathophysiology of HIV D) Teaching the patient about the need for follow-up blood work

Ans: B Feedback: ART is highly dependent on adherence to treatment, and the nurse should proactively address this. Blood work is necessary, but this will not have a direct bearing on the success or failure of treatment. Complementary therapies are appropriate, but are not the main factor in successful treatment. The patient may or may not benefit from teaching about HIV pathophysiology.

35. A hospital nurse has experienced percutaneous exposure to an HIV-positive patients blood as a result of a needlestick injury. The nurse has informed the supervisor and identified the patient. What action should the nurse take next? A) Flush the wound site with chlorhexidine. B) Report to the emergency department or employee health department. C) Apply a hydrocolloid dressing to the wound site. D) Follow up with the nurses primary care provider.

Ans: B Feedback: After initiating the emergency reporting system, the nurse should report as quickly as possible to the employee health services, the emergency department, or other designated treatment facility. Flushing is recommended, but chlorhexidine is not used for this purpose. Applying a dressing is not recommended. Following up with the nurses own primary care provider would require an unacceptable delay.

13. A nurse is performing an admission assessment on a patient with stage 3 HIV. After assessing the patients gastrointestinal system and analyzing the data, what is most likely to be the priority nursing diagnosis? A) Acute Abdominal Pain B) Diarrhea C) Bowel Incontinence D) Constipation

Ans: B Feedback: Diarrhea is a problem in 50% to 60% of all AIDS patients. As such, this nursing diagnosis is more likely than abdominal pain, incontinence, or constipation, though none of these diagnoses is guaranteed not to apply.

29. A patient has come into contact with HIV. As a result, HIV glycoproteins have fused with the patients CD4+ T-cell membranes. This process characterizes what phase in the HIV life cycle? A) Integration B) Attachment C) Cleavage D) Budding

Ans: B Feedback: During the process of attachment, glycoproteins of HIV bind with the hosts uninfected CD4+ receptor and chemokine coreceptors, which results in fusion of HIV with the CD4+ T-cell membrane. Integration, cleavage, and budding are steps that are subsequent to this initial phase of the HIV life cycle.

3. A nurse is assessing a 28-year-old man with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority? Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 694 A) Oral temperature of 100F B) Tachypnea and restlessness C) Frequent loose stools D) Weight loss of 1 pound since yesterday

Ans: B Feedback: In prioritizing care, the pneumonia would be assessed first by the nurse. Tachypnea and restlessness are symptoms of altered respiratory status and need immediate priority. Weight loss of 1 pound is probably fluid related; frequent loose stools would not take short-term precedence over a temperature or tachypnea and restlessness. An oral temperature of 100F is not considered a fever and would not be the first issue addressed.

26. A patient with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education? A) Appropriate use of prophylactic antibiotics B) Importance of personal hygiene C) Signs and symptoms of wasting syndrome D) Strategies for adjusting antiretroviral dosages

Ans: B Feedback: Infection control is of high importance in patients living with HIV, thus personal hygiene is paramount. This is a more important topic than signs and symptoms of one specific complication (wasting syndrome). Drug dosages should never be independently adjusted. Prophylactic antibiotics are not normally prescribed unless the patients CD4 count is below 50.

39. A patient who has AIDS has been admitted for the treatment of Kaposis sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS? A) Risk for Disuse Syndrome Related to Kaposis Sarcoma B) Impaired Skin Integrity Related to Kaposis Sarcoma C) Diarrhea Related to Kaposis Sarcoma Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 710 D) Impaired Swallowing Related to Kaposis Sarcoma

Ans: B Feedback: Kaposis sarcoma (KS) is a disease that involves the endothelial layer of blood and lymphatic vessels. This malignancy does not directly affect swallowing or bowel motility and it does not constitute a risk for disuse syndrome.

24. A patient is in the primary infection stage of HIV. What is true of this patients current health status? A) The patients HIV antibodies are successfully, but temporarily, killing the virus. B) The patient is infected with HIV but lacks HIV-specific antibodies. C) The patients risk for opportunistic infections is at its peak. D) The patient may or may not develop long-standing HIV infection.

Ans: B Feedback: The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection. The virus is not being eradicated and infection is certain. Opportunistic infections emerge much later in the course of the disease.

31. A patient with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this patient should expect the physician to order what drug for the management of the patients diarrhea? A) Zithromax B) Sandostatin C) Levaquin D) Biaxin

Ans: B Feedback: Therapy with octreotide acetate (Sandostatin), a synthetic analogue of somatostatin, has been shown to be effective in managing chronic severe diarrhea. Zithromax, Levaquin, and Biaxin are not used to treat chronic severe diarrhea.

9. A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize which of the following interventions? A) Lifestyle actions that improve immune function B) Educational programs that focus on control and prevention C) Appropriate use of standard precautions D) Screening programs for youth and young adults

Ans: B Feedback: Until an effective vaccine is developed, preventing HIV by eliminating and reducing risk behaviors is essential. Educational interventions are the primary means by which behaviors can be influenced. Screening is appropriate, but education is paramount. Enhancing immune function does not prevent HIV infection. Ineffective use of standard precautions apply to very few cases of HIV infection. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 697

10. A nurse is working with a patient who was diagnosed with HIV several months earlier. The nurse should recognize that a patient with HIV is considered to have AIDS at the point when the CD4+ T-lymphocyte cell count drops below what threshold? A) 75 cells/mm3 of blood B) 200 cells/mm3 of blood C) 325 cells/mm3 of blood D) 450 cells/mm3 of blood

Ans: B Feedback: When CD4+ T-cell levels drop below 200 cells/mm3 of blood, the person is said to have AIDS.

25. A patients primary infection with HIV has subsided and an equilibrium now exists between HIV levels and the patients immune response. This physiologic state is known as which of the following? A) Static stage B) Latent stage C) Viral set point D) Window period

Ans: C Feedback: The remaining amount of virus in the body after primary infection is referred to as the viral set point, which results in a steady state of infection that lasts for years. This is not known as the static or latent stage. The window period is the time a person infected with HIV tests negative even though he or she is Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 704 infected.

28. The nurse is caring for a patient who has been admitted for the treatment of AIDS. In the morning, the patient tells the nurse that he experienced night sweats and recently coughed up some blood. What is the nurses most appropriate action? Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 705 A) Assess the patient for additional signs and symptoms of Kaposis sarcoma. B) Review the patients most recent viral load and CD4+ count. C) Place the patient on respiratory isolation and inform the physician. D) Perform oral suctioning to reduce the patients risk for aspiration.

Ans: C Feedback: These signs and symptoms are suggestive of tuberculosis, not Kaposis sarcoma; prompt assessment and treatment is necessary. There is no indication of a need for oral suctioning and the patients blood work will not reflect the onset of this opportunistic infection.

20. A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits which of the following behaviors? A) The nurse wears face protection, gloves, and a gown when irrigating a wound. B) The nurse washes the hands with a waterless antiseptic agent after removing a pair of soiled gloves. C) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. D) The nurse places a used needle and syringe in the puncture-resistant container without capping the needle.

Ans: C Feedback: Gloves must be changed after contact with materials that may contain high concentration of microorganisms, even when working with the same patient. Each of the other listed actions adheres to standard precautions.

32. A patient with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in AIDS patients by increasing body fat stores? A) Advera B) Momordicacharantia C) Megestrol D) Ranitidine

Ans: C Feedback: Megestrol acetate (Megace), a synthetic oral progesterone preparation, promotes significant weight gain. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 707 In patients with HIV infection, it increases body weight primarily by increasing body fat stores. Advera is a nutritional supplement that has been developed specifically for people with HIV infection and AIDS. Momordicacharantia (bitter melon) is given as an enema and is part of alternative treatment for HIV/AIDS. Ranitidine prevents ulcers.

36. The nurse care plan for a patient with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care? A) Maximize the patients fluid intake. B) Provide total parenteral nutrition (TPN). C) Keep the patients bed linens free of wrinkles. D) Provide the patient with snug clothing at all times.

Ans: C Feedback: Skin surfaces are protected from friction and rubbing by keeping bed linens free of wrinkles and avoiding tight or restrictive clothing. Fluid intake should be adequate, and must be monitored, but maximizing fluid intake is not a goal. TPN is a nutritional intervention of last resort.

15. A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results? A) Another EIA test B) Viral load test C) Western blot test D) CD4/CD8 ratio

Ans: C Feedback: The Western blot test detects antibodies to HIV and is used to confirm the EIA test results. The viral load test measures HIV RNA in the plasma and is not used to confirm EIA test results, but instead to track the progression of the disease process. The CD4/CD8 ratio test evaluates the ratio of CD4 and CD8 cells but is not used to confirm results of EIA testing.

6. The mother of two young children has been diagnosed with HIV and expresses fear of dying. How should the nurse best respond to the patient? A) Would you like me to have the chaplain come speak with you? B) Youll learn much about the promise of a cure for HIV. C) Can you tell me what concerns you most about dying? D) You need to maintain hope because you may live for several years.

Ans: C Feedback: The nurse can help the patient verbalize feelings and identify resources for support. The nurse should respond with an open-ended question to help the patient to identify fears about being diagnosed with a life-threatening chronic illness. Immediate deferral to spiritual care is not a substitute for engaging with the patient. The nurse should attempt to foster hope, but not in a way that downplays the patients expressed fears.

14. A patient with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond? A) Complementary therapies generally have not been approved, so patients are usually discouraged from using them. B) Researchers have not looked at the benefits of alternative therapy for patients with HIV, so we suggest that you stay away from these therapies until there is solid research data available. C) Many patients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks. D) Youll need to meet with your doctor to choose between an alternative approach to treatment and a medical approach. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 699

Ans: C Feedback: The nurse should approach the topic of alternative or complementary therapies from an open-ended, supportive approach, emphasizing the need to communicate with care providers. Complementary therapies and medical treatment are not mutually exclusive, though some contraindications exist. Research supports the efficacy of some forms of complementary and alternative treatment.

PE Medical/Nursing Management

Medical ~Unstable- Stabilize cardiopulmonary, May need emergency measures ~Stable- Cardiovascular stability, immediate anticoagulation is indicated Nursing ~Managing Oxygen Therapy!!! ~Monitoring thrombolytic therapy ~Managing pain ~Relieving anxiety ~Post op care ~Transition home care

37. A patient has been diagnosed with AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate for this patient? A) Position the patient in the high Fowlers position whenever possible. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 709 B) Temporarily eliminate animal protein from the patients diet. C) Make sure the patient eats at least two servings of raw fruit each day. D) Obtain a stool culture to identify possible pathogens.

Ans: D Feedback: A stool culture should be obtained to determine the possible presence of microorganisms that cause diarrhea. Patients should generally avoid raw fruit when having diarrhea. There is no need to avoid animal protein or increase the height of the patients bed.

21. An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her baby is going to be born with HIV. What is the nurses best response? A) There is no way to know that for certain, but we do know that your baby has a one in four chance of being born with HIV. B) Your physician is likely the best one to ask that question. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 702 C) If the baby is HIV positive there is nothing that can be done until it is born, so try your best not to worry about it now. D) Its possible that your baby could contract HIV, either before, during, or after delivery.

Ans: D Feedback: Mother-to-child transmission of HIV-1 is possible and may occur in utero, at the time of delivery, or through breast-feeding. There is no evidence that the infants risk is 25%. Deferral to the physician is not a substitute for responding appropriately to the patients concern. Downplaying the patients concerns is inappropriate.

23. A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen what she needs and the teen responds that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do keep from getting HIV. What would be the nurses best response? A) Theres no way to be sure you wont get HIV except to use condoms correctly. B) Only the correct use of a female condom protects against the transmission of HIV. C) There are new ways of protecting yourself from HIV that are being discovered every day. D) Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV. Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 703

Ans: D Feedback: Other than abstinence, consistent and correct use of condoms is the only effective method to decrease the risk of sexual transmission of HIV infection. Both female and male condoms confer significant protection. New prevention techniques are not commonly discovered, though advances in treatment are constant.

4. A patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows that antibodies to the AIDS virus are present in the blood, this indicates what? A) The patient is immune to HIV. B) The patients immune system is intact. C) The patient has AIDS-related complications. D) The patient has been infected with HIV.

Ans: D Feedback: Positive test results indicate that antibodies to the AIDS virus are present in the blood. The presence of antibodies does not imply an intact immune system or specific immunity to HIV. This finding does not indicate the presence of AIDS-related complications.

11. During the admission assessment of an HIV-positive patient whose CD4+ count has recently fallen, the nurse carefully assesses for signs and symptoms related to opportunistic infections. What is the most common life-threatening infection? A) Salmonella infection B) Mycobacterium tuberculosis C) Clostridium difficile D) Pneumocystis pneumonia

Ans: D Feedback: There are a number of opportunistic infections that can infect individuals with AIDS. The most common life-threatening infection in those living with AIDS is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly carinii). Other opportunistic infections may involve Salmonella,Mycobacterium tuberculosis, and Clostridium difficile.

7. The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, what should the nurse tell the attendees? A) Attach the condom prior to erection. B) A condom may be reused with the same partner if ejaculation has not occurred. C) Use skin lotion as a lubricant if alternatives are unavailable. D) Hold the condom by the cuff upon withdrawal.

Ans: D Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 696 Feedback: The condom should be unrolled over the hard penis before any kind of sex. The condom should be held by the tip to squeeze out air. Skin lotions, baby oil, petroleum jelly, or cold cream should not be used with condoms because they cause latex deterioration/condom breakage. The condom should be held during withdrawal so it does not come off the penis. Condoms should never be reused.

A client has been diagnosed as experiencing "white-coat hypertension." This refers to: anxiety insomnia depression loss of consciousness

Anxiety

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis?

Anxiety

The nurse is caring for a client admitted to the ED with an uncomplicated nasal fracture. Nasal packing has been put in place. Which intervention should the nurse include in the client's care?

Apply an ice pack.

A client comes into the Emergency Department with epistaxis. What intervention should you perform when caring for a client with epistaxis?

Apply direct continuous pressure.

A client comes into the emergency department with epistaxis. What intervention should the nurse perform when caring for a client with epistaxis?

Apply direct continuous pressure.

A patient playing softball was hit in the nose by the ball and has been determined to have an uncomplicated fractured nose with epistaxis. The nurse should prepare to assist the physician with what tasks?

Applying nasal packing

Arteriosclerosis and Atherosclerosis

Arteriosclerosis- Hardening of the arteries. Is the most common disease of the arteries Atherosclerosis- Affects the intima of large and medium-sized arteries. ~Accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery (atheromas or plaques) ~Can be used interchangeable because one rarely occurs without the other

Instructions for the patient with low back pain include that when lifting the patient should a) place the load away from the body. b) bend the knees and loosen the abdominal muscles. c) avoid overreaching. d) use a narrow base of support.

Avoid overreaching. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. When lifting, the patient with low back pain should keep the load close to the body. When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles.

The nurse is providing discharge instructions to a client who has nasal packing in place following nasal surgery. Which discharge instructions would be most appropriate for the client?

Avoid sports activities for 6 weeks.

A client newly diagnosed with type 2 diabetes has been told by their family that they can no longer consume alcohol. The client asks the nurse if abstaining from all alcohol is necessary. What is the nurse's best response? A. "You should stop all alcohol intake. Alcohol is absorbed by your body before other important nutrients and may lead to very high blood glucose levels." B. "You do not need to give up alcohol entirely but there are potential side effects specific to clients with diabetes that you should consider." C. "You should no longer consume alcohol since it causes immediate low blood glucose levels in diabetic clients." D. "You can still consume alcohol, but limit your consumption to no more than 3 glasses of wine or beer daily because of the high sugar content of alcohol."

B

A client with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the client's initial phase of treatment? A. Monitoring the client for dysrhythmias B. Maintaining and monitoring the client's fluid balance C. Assessing the client's level of consciousness D. Assessing the client for signs and symptoms of venous thromboembolism

B

A client with diabetes is asking the nurse what causes diabetic ketoacidosis (DKA). Which of the following is a correct statement by the nurse? A. "DKA can be caused by taking too much insulin." B. "DKA can be caused by taking too little insulin." C. "DKA can happen without a cause." D. "DKA will not happen with type 1 diabetes."

B

A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what factor most likely caused this short-term change in treatment? A. Alterations in bile metabolism and release have likely caused hyperglycemia. B. Stress has likely caused an increase in the client's blood sugar levels. C. The client's efforts did not control the diabetes using nonpharmacologic measures. D. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

B

A nurse is caring for a client with type 1 diabetes. The client's medication administration record includes the administration of regular insulin three times daily. Knowing that the client's lunch tray will arrive at 11:45 AM, when should the nurse administer the client's insulin? A. 10:45 AM B. 11:30 AM C. 11:45 AM D. 11:50 AM

B

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as being suggestive of diabetes? A. "I've always been a fan of sweet foods, but lately I'm turned off by them." B. "Lately, I drink and drink and can't seem to quench my thirst." C. "No matter how much sleep I get, it seems to take me hours to wake up." D. "When I went to the washroom the last few days, my urine smelled odd."

B

The nurse is discussing macrovascular complications of diabetes with a client. The nurse would address what topic during this dialogue? A. The need for frequent eye examinations for clients with diabetes B. The fact that clients with diabetes have an elevated risk of myocardial infarction C. The relationship between kidney function and blood glucose levels D. The need to monitor urine for the presence of albumin

B

The nurse reviews foot care with an older adult client. Why would the nurse feel that foot care is so important to this client? A. An older adult client with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. C. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. D. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.

B

PAD Medical/Nursing Managments

Medical ~Walking program ~Pharmacologic therapy ~Endovascular management (balloon, stent, ect) ~Surgical management Nursing ~Nursing care of the postoperative patient after procedure -> Maintain circulation!!!, monitor and manage complications, promote home care, community-based and transitional care

40. A patient presents to the emergency department with paraphimosis. The physician is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, what is usually indicated? A) Needle aspiration of the corpus cavernosum B) Circumcision C) Abstinence from sexual activity for 6 weeks D) Administration of vardenafil

B Feedback: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is Levitra and would not be used for paraphimosis.

Which of the following clinical manifestations would the nurse expect to find in a client who has Paget's disease? a) Dowager's hump b) Flexion deformity of the toe c) Bowing of the legs d) High arch of the foot

Bowing of the legs Explanation: Paget's disease is characterized by pain and bowing of the legs.

15. A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patient's history, what might the nurse note that contributes to erectile dysfunction? A) The patient has been treated for a UTI twice in the past year. B) The patient has a history of hypertension. C) The patient is 66 years old. D) The patient leads a sedentary lifestyle.

B Feedback: Past history of infection and lack of exercise do not contribute to impotence. With advancing age, sexual function and libido and potency decrease somewhat, but this is not the primary reason for impotence. Vascular problems cause about half the cases of impotence in men older than 50 years; hypertension is a major cause of such problems.

10. A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history prior to instructing the patient on the use of this medication. What disorder will contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Retinopathy C) Hypotension D) Diabetic nephropathy

B Feedback: Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually contraindicated with diabetic retinopathy.

23. A 75-year-old male patient is being treated for phimosis. When planning this patient's care, what health promotion activity is most directly related to the etiology of the patient's health problem? A) Teaching the patient about safer sexual practices B) Teaching the patient about the importance of hygiene C) Teaching the patient about the safe use of PDE-5 inhibitors D) Teaching the patient to perform testicular self-examination

B Feedback: Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.

21. A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy? A) There will be no ejaculate after a vasectomy, though the patient's potential for orgasm is unaffected. B) There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. C) There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction. D) There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.

B Feedback: Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.

A client is brought to the emergency department. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply. A. Leukocytosis B. Glycosuria C. Dehydration D. Hypernatremia E. Hyperglycemia

B, C, E

35. A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply. A) Abstaining from sexual intercourse for at least 14 days postprocedure B) Wearing a scrotal support garment C) Using sitz baths D) Applying a heating pad intermittently E) Staying on bed rest for 48 to 72 hours postprocedure

B,C Feedback: Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the patient to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.

The admissions department at a local hospital is registering an elderly man for an outpatient diagnostic test. The admissions nurse asks the man if he has an advanced directive. The man responds that he does not want to complete an advance directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this patient? A. "Advance directives are not legal documents, so you have nothing to worry about." B. "Advance directives are limited only to health care instructions and directives." C. "Your finances cannot be managed without an advance directive." D. "Advance directives are implemented when you become incapacitated, and then you will use a living will to allow the state to manage your money."

B. "Advance directives are limited only to health care instructions and directives." An advance directive is a formal, legally endorsed document that provides instructions for care (living will) or names a proxy decision maker (durable power of attorney for health care) and covers only issues related specifically to health care, not financial issues. They do not address financial issues. Advance directives are implemented when a patient becomes incapacitated, but financial issues are addressed with a durable power of attorney for finances, or financial power of attorney.

While auscultating a patient's heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). An audible S3 would be considered an expected finding in what patient? A. An older adult B. A 20 year old patient C. A patient who has undergone valve replacement D. A patient who takes a beta adrenergic blocker

B. A 20 year old patient S3 represents a normal finding in children and adults up to 35 or 40 years of age. In these cases, it is called a physiologic S3. It is an abnormal finding in a patient with an artificial valve, an older adult, or a patient who takes a beta blocker.

You are the nurse planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiological changes. What phenomenon would you include in your teaching plan? A. A decrease in cognition, judgment, and memory B. A decrease in muscle mass and bone density C. The disappearance of sexual desire for both men and women D. An increase in sebaceous and sweat gland function in both men and women

B. A decrease in muscle mass and bone density Normal signs of aging include a decrease in the sense of smell, a decrease in muscle mass, a decline but not disappearance of sexual desire, and decreased sebaceous and sweat glands for both men and women. Cognitive changes are usually attributable to pathologic processes, not healthy aging.

The nurse is caring for a patient who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output? A. A change in position from standing to sitting B. A heart rate of 54 bpm C. A pulse oximetry reading of 94% D. An increase in preload related to ambulation

B. A heart rate of 54 bpm Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.

A gerontologic nurse is making an effort to address some of the misconceptions about older adults that exist among health care providers. The nurse has made the point that most people aged 75 years remains functionally independent. The nurse should attribute this trend to what factor? A. Early detection of disease and increased advocacy by older adults B. Application of health-promotion and disease-prevention activities C. Changes in the medical treatment of hypertension and hyperlipidemia D. Genetic changes that have resulted in increased resiliency to acute infection

B. Application of health-promotion and disease-prevention activities Even among people 75 years of age and over, most remain functionally independent, and the proportion of older Americans with limitations in activities is declining. These declines in limitations reflect recent trends in health-promotion and disease-prevention activities, such as improved nutrition, decreased smoking, increased exercise, and early detection and treatment of risk factors such as hypertension and elevated serum cholesterol levels. This phenomenon is not attributed to genetics, medical treatment, or increased advocacy.

The nurse has just taken report on a newly admitted patient who is a 15-year-old girl who is a recent immigrant to the United States. When planning interventions for this patient, the nurse knows the interventions must be which of the following? Select all that apply. A. Appropriate to the nurse's preferences B. Appropriate to the patient's age C. Ethical D. Appropriate to the patient's culture E. Applicable to others with the same diagnosis

B. Appropriate to the patient's age C. Ethical D. Appropriate to the patient's culture Planned interventions should be ethical and appropriate to the patient's culture, age, and gender. Planned interventions do not have to be in alignment with the nurse's preferences nor do they have to be shared by everyone with the same diagnosis.

A gerontologic nurse has been working hard to change the perceptions of the elderly, many of which are negative, by other segments of the population. What negative perceptions of older people have been identified in the literature? Select all that apply. A. As being the cause of social problems B. As not contributing to society C. As draining economic resources D. As competing with children for resources E. As dominating health care research

B. As not contributing to society C. As draining economic resources D. As competing with children for resources Retirement and perceived nonproductivity are responsible for negative feelings because a younger working person may falsely see older people as not contributing to society and as draining economic resources. Younger working people may actually feel that older people are in competition with children for resources. However, the older population is generally not seen as dominating health care research or causing social problems.

A nurse is unsure how best to respond to a patient's vague complaint of "feeling off." The nurse is attempting to apply the principles of critical thinking, including metacognition. How can the nurse best foster metacognition? A. By eliciting input from a variety of trusted colleagues B. By examining the way that she thinks and applies reason C. By evaluating her responses to similar situations in the past D. By thinking about the way that an "ideal" nurse would respond in this situation

B. By examining the way that she thinks and applies reason Critical thinking includes metacognition, the examination of one's own reasoning or thought processes, to help refine thinking skills. Metacognition is not characterized by eliciting input from others or evaluating previous responses.

The case manager is working with an 84-year-old patient newly admitted to a rehabilitation facility. When developing a care plan for this older adult, which factors should the nurse identify as positive attributes that benefit coping in this age group? Select all that apply. A. Decreased risk taking B. Effective adaptation skills C. Avoiding participation in untested roles D. Increased life experience E. Resiliency during change

B. Effective adaptation skills D. Increased life experience E. Resiliency during change Because changes in life patterns are inevitable over a lifetime, older people need resiliency and coping skills when confronting stresses and change. It is beneficial if older adults continue to participate in risk taking and participation in new, untested roles.

In response to a patient's complaint of pain, the nurse administered a PRN dose of hydromorphone (Dilaudid). In what phase of the nursing process will the nurse determine whether this medication has had the desired effect? A. Analysis B. Evaluation C. Assessment D. Data collection

B. Evaluation Evaluation, the final step of the nursing process, allows the nurse to determine the patient's response to nursing interventions and the extent to which the objectives have been achieved.

A 47-year-old patient who has come to the physician's office for his annual physical is being assessed by the office nurse. The nurse who is performing routine health screening for this patient should be aware that one of the first physical signs of aging is what? A. Having more frequent aches and pains B. Failing eyesight, especially close vision C. Increasing loss of muscle tone D. Accepting limitations while developing assets

B. Failing eyesight, especially close vision Failing eyesight, especially close vision, is one of the first signs of aging in middle life. More frequent aches and pains begin in the "early" late years (between ages 65 and 79). Increase in loss of muscle tone occurs in later years (ages 80 and older). Accepting limitations while developing assets is socialization development that occurs in adulthood.

Gerontologic nursing is a specialty area of nursing that provides care for the elderly in our population. What goal of care should a gerontologic nurse prioritize when working with this population? A. Helping older adults determine how to reduce their use of external resources B. Helping older adults use their strengths to optimize independence C. Helping older adults promote social integration D. Helping older adults identify the weaknesses that most limit them

B. Helping older adults use their strengths to optimize independence Gerontologic nursing is provided in acute care, skilled and assisted living, community, and home settings. The goals of care include promoting and maintaining functional status and helping older adults identify and use their strengths to achieve optimal independence. Goals of gerontologic nursing do not include helping older adults "promote social integration" or identify their weaknesses. Optimal independence does not necessarily involve reducing the use of available resources.

An adult patient has requested a "do not resuscitate" (DNR) order in light of his recent diagnosis with late stage pancreatic cancer. The patient's son and daughter-in-law are strongly opposed to the patient's request. What is the primary responsibility of the nurse in this situation? A. Perform a "slow code" until a decision is made. B. Honor the request of the patient. C. Contact a social worker or mediator to intervene. D. Temporarily withhold nursing care until the physician talks to the family.

B. Honor the request of the patient. The nurse must honor the patient's wishes and continue to provide required nursing care. Discussing the matter with the physician may lead to further communication with the family, during which the family may reconsider their decision. It is not normally appropriate for the nurse to seek the assistance of a social worker or mediator. A "slow code" is considered unethical.

The critical care nurse is caring for a patient with a central venous pressure (CVP) monitoring system. The nurse notes that the patient's CVP is increasing. Of what may this indicate? A. Psychosocial stress B. Hypervolemia C. Dislodgment of the catheter D. Hypomagnesemia

B. Hypervolemia CVP is a useful hemodynamic parameter to observe when managing an unstable patient's fluid volume status. An increasing pressure may be caused by hypervolemia or by a condition, such as heart failure, that results in decreased myocardial contractility. Stress, dislodgement of the catheter, and low magnesium levels would not typically result in increased CVP.

Older people have many altered reactions to disease that are based on age-related physiological changes. When the nurse observes physical indicators of illness in the older population, that nurse must remember which of the following principles? A. Potential life-threatening problems in the older adult population are not as serious as they are in a middle-aged population. B. Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults. C. The same physiological processes that indicate serious health care problems in a younger population indicate mild disease states in the elderly. D. Middle-aged people do not react to disease states the same as a younger population does.

B. Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults. Physical indicators of illness that are useful and reliable in young and middle-aged people cannot be relied on for the diagnosis of potential life-threatening problems in older adults. Option A is incorrect because a potentially life-threatening problem in an older person is more serious than it would be in a middle-aged person because the older adult does not have the physical resources of the middle-aged person. Physical indicators of serious health care problems in a young or middle-aged population do not indicate disease states that are considered "mild" in the elderly population. It is true that middle-aged people do not react to disease states the same as a younger population, but this option does not answer the question.

A nurse provides care on an orthopedic reconstruction unit and is admitting two new patients, both status post knee replacement. What would be the best explanation why their care plans may be different from each other? A. Patients may have different insurers, or one may qualify for Medicare. B. Individual patients are seen as unique and dynamic, with individual needs. C. Nursing care may be coordinated by members of two different health disciplines. D. Patients are viewed as dissimilar according to their attitude toward surgery.

B. Individual patients are seen as unique and dynamic, with individual needs. Regardless of the setting, each patient situation is viewed as unique and dynamic. Differences in insurance coverage and attitude may be relevant, but these should not fundamentally explain the differences in their nursing care. Nursing care should be planned by nurses, not by members of other disciplines.

During a shift assessment, the nurse is identifying the client's point of maximum impulse (PMI). Where will the nurse best palpate the PMI? A. Left midclavicular line of the chest at the level of the nipple B. Left midclavicular line of the chest at the fifth intercostal space C. Midline between the xiphoid process and the left nipple D. Two to three centimeters to the left of the sternum

B. Left midclavicular line of the chest at the fifth intercostal space The left ventricle is responsible for the apical beat or the point of maximum impulse, which is normally palpated in the left midclavicular line of the chest wall at the fifth intercostal space.

You are providing care for an 82-year-old man whose signs and symptoms of Parkinson disease have become more severe over the past several months. The man tells you that he can no longer do as many things for himself as he used to be able to do. What factor should you recognize as impacting your patient's life most significantly? A. Neurologic deficits B. Loss of independence C. Age-related changes D. Tremors and decreased mobility

B. Loss of independence This patient's statement places a priority on his loss of independence. This is undoubtedly a result of the neurologic changes associated with his disease, but this is not the focus of his statement. This is a disease process, not an age-related physiological change.

The physical therapist notifies the nurse that a patient with coronary artery disease (CAD) experiences a much greater than average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient with CAD may result in what? A. Development of an atrialseptal defect B. Myocardial ischemia C. Formation of a pulmonary embolism D. Release of potassium ions from cardiac cells

B. Myocardial ischemia Unlike other arteries, the coronary arteries are perfused during diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Patients, particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not usually result in a pulmonary embolism or create electrolyte imbalances. Atrialseptal defects are congenital.

A nurse has begun creating a patient's plan of care shortly after the patient's admission. It is important that the wording of the chosen nursing diagnoses falls within the taxonomy of nursing. Which organization is responsible for developing the taxonomy of a nursing diagnosis? A. American Nurses Association (ANA) B. NANDA C. National League for Nursing (NLN) D. Joint Commission

B. NANDA NANDA International is the official organization responsible for developing the taxonomy of nursing diagnoses and formulating nursing diagnoses acceptable for study. The ANA, NLN, and Joint Commission are not charged with the task of developing the taxonomy of nursing diagnoses.

While developing the plan of care for a new patient on the unit, the nurse must identify expected outcomes that are appropriate for the new patient. What resource should the nurse prioritize for identifying these appropriate outcomes? A. Community Specific Outcomes Classification (CSO) B. Nursing-Sensitive Outcomes Classification (NOC) C. State Specific Nursing Outcomes Classification (SSNOC) D. Department of Health and Human Services Outcomes Classification (DHHSOC)

B. Nursing-Sensitive Outcomes Classification (NOC) Resources for identifying appropriate expected outcomes include the NOC and standard outcome criteria established by health care agencies for people with specific health problems. The other options are incorrect because they do not exist.

The nurse is caring for a patient who is withdrawing from heavy alcohol use and who is consequently combative and confused, despite the administration of benzodiazepines. The patient has a fractured hip that he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriate action for the nurse to take? A. Leave the patient and get help. B. Obtain a physician's order to restrain the patient. C. Read the facility's policy on restraints. D. Order soft restraints from the storeroom.

B. Obtain a physician's order to restrain the patient. It is mandatory in most settings to have a physician's order before restraining a patient. Before restraints are used, other strategies, such as asking family members to sit with the patient, or utilizing a specially trained sitter, should be tried. A patient should never be left alone while the nurse summons assistance.

Planning for pandemic

• HIV, H1N1, COVID-19 • U.S. Department of Health and Human Services • Responsibilities at federal, state, local levels • Coordination with WHO, international organizations

Mrs. Harris is an 83-year-old woman who has returned to the community following knee replacement surgery. The community health nurse recognizes that Mrs. Harris has prescriptions for nine different medications for the treatment of varied health problems. In addition, she has experienced occasional episodes of dizziness and lightheadedness since her discharge. The nurse should identify which of the following nursing diagnoses? A. Risk for infection related to polypharmacy and hypotension B. Risk for falls related to polypharmacy and impaired balance C. Adult failure to thrive related to chronic disease and circulatory disturbance D. Disturbed thought processes related to adverse drug effects and hypotension

B. Risk for falls related to polypharmacy and impaired balance Polypharmacy and loss of balance are major contributors to falls in the elderly. This patient does not exhibit failure to thrive or disturbed thought processes. There is no evidence of a heightened risk of infection.

The nursing instructor cites a list of skills that support critical thinking in clinical situations. The nurse should describe skills in which of the following domains? Select all that apply. A. Self-esteem B. Self-regulation C. Inference D. Autonomy E. Interpretation

B. Self-regulation C. Inference E. Interpretation Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Self-esteem and autonomy would not be on the list because they are not skills.

You are the nurse caring for an elderly patient with cardiovascular disease. The patient comes to the clinic with a suspected respiratory infection and is diagnosed with pneumonia. As the nurse, what do you know about the altered responses of older adults? A. Treatments for older adults need to be more holistic than treatments used in the younger population. B. The altered responses of older adults reinforce the need for the nurse to monitor all body systems to identify possible systemic complications. C. The altered responses of older adults define the nursing interactions with the patient. D. Older adults become hypersensitive to antibiotic treatments for infectious disease states.

B. The altered responses of older adults reinforce the need for the nurse to monitor all body systems to identify possible systemic complications. Older people may be unable to respond effectively to an acute illness, or, if a chronic health condition is present, they may be unable to sustain appropriate responses over a long period. Furthermore, their ability to respond to definitive treatment is impaired. The altered responses of older adults reinforce the need for nurses to monitor all body system functions closely, being alert to signs of impending systemic complication. Holism should be integrated into all patients' care. Altered responses in the older adult do not define the interactions between the nurse and the patient. Older adults do not become hypersensitive to antibiotic treatments for infectious disease states.

You are caring for a patient with late-stage Alzheimer's disease. The patient's wife tells you that the patient has now become completely dependent and that she feels guilty if she takes any time for herself. What outcomes would be appropriate for the nurse to develop to assist the patient's wife? A. The caregiver learns to explain to the patient why she needs time for herself. B. The caregiver distinguishes essential obligations from those that can be controlled or limited. C. The caregiver leaves the patient at home alone for short periods of time to encourage independence. D. The caregiver prioritizes her own health over that of the patient

B. The caregiver distinguishes essential obligations from those that can be controlled or limited. For prolonged periods, it is not uncommon for caregivers to neglect their own emotional and health needs. The caregiver must learn to distinguish obligations that she must fulfill and limit those that are not completely necessary. The caregiver can tell the patient when she leaves, but she should not expect that the patient will remember or will not become angry with her for leaving. The caregiver should not leave the patient home alone for any length of time because it may compromise the patient's safety. Being thoughtful and selective with her time and energy is not synonymous with prioritizing her own health over than of the patient; it is more indicative of balance and sustainability.

A nurse has been offered a position on an obstetric unit and has learned that the unit offers therapeutic abortions, a procedure which contradicts the nurse's personal beliefs. What is the nurse's ethical obligation to these patients? A. The nurse should adhere to professional standards of practice and offer service to these patients. B. The nurse should make the choice to decline this position and pursue a different nursing role. C. The nurse should decline to care for the patients considering abortion. D. The nurse should express alternatives to women considering terminating their pregnancy.

B. The nurse should make the choice to decline this position and pursue a different nursing role. To avoid facing ethical dilemmas, nurses can follow certain strategies. For example, when applying for a job, a nurse should ask questions regarding the patient population. If a nurse is uncomfortable with a particular situation, then not accepting the position would be the best option. The nurse is only required by law (and practice standards) to provide care to the patients the clinic accepts; the nurse may not discriminate between patients and the nurse expressing his or her own opinion and providing another option is inappropriate.

A medical nurse is caring for a patient who is palliative following metastasis. The nurse is aware of the need to uphold the ethical principle of beneficence. How can the nurse best exemplify this principle in the care of this patient? A. The nurse tactfully regulates the number and timing of visitors as per the patient's wishes. B. The nurse stays with the patient during his or her death. C. The nurse ensures that all members of the care team are aware of the patient's DNR order. D. The nurse liaises with members of the care team to ensure continuity of care.

B. The nurse stays with the patient during his or her death. Beneficence is the duty to do good and the active promotion of benevolent acts. Enacting the patient's wishes around visitors is an example of this. Each of the other nursing actions is consistent with ethical practice, but none directly exemplifies the principle of beneficence.

A resident of a longterm care facility has complained to the nurse of chest pain. What aspect of the resident's pain would be most suggestive of angina as the cause? A. The pain is worse when the resident inhales deeply. B. The pain occurs immediately following physical exertion. C. The pain is worse when the resident coughs. D. The pain is most severe when the resident moves his upper body.

B. The pain occurs immediately following physical exertion. Chest pain associated with angina is often precipitated by physical exertion. The other listed aspects of chest pain are more closely associated with noncardiac etiologies.

MRSA

• Health care-associated • Community-associated

An elderly patient is admitted to your unit with a diagnosis of community-acquired pneumonia. During admission the patient states, "I have a living will." What implication of this should the nurse recognize? A. This document is always honored, regardless of circumstances. B. This document specifies the patient's wishes before hospitalization. C. This document that is binding for the duration of the patient's life. D. This document has been drawn up by the patient's family to determine DNR status.

B. This document specifies the patient's wishes before hospitalization A living will is one type of advance directive. In most situations, living wills are limited to situations in which the patient's medical condition is deemed terminal. The other answers are incorrect because living wills are not always honored, they are not binding for the duration of the patient's life, and they are not drawn up by the patient's family.

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Better molding to the client

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately?

Bleeding

Vagal blocking

Blocking of vagus nerve via implanted device - diminished gastric contraction & emptying, limited ghrelin secretion, & diminished pancreatic enzyme secretion = increased satiety, decreased cravings, diminished absorption of calories

An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? C-reactive protein (CRP) levels Sodium, chloride, and potassium levels Arterial blood gas (ABG) results Blood urea nitrogen (BUN) and creatinine levels

Blood urea nitrogen (BUN) and creatinine levels

The nurse recognizes that the client with osteomyelitis is at risk for: a) Bone abscess formation b) Impingement syndrome c) Metastatic bone disease d) Pathological fractures

Bone abscess formation Explanation: Bone abscess formation is a potential complication of osteomyelitis.

The nurse recognizes that the client with osteomyelitis is at risk for: a) Metastatic bone disease b) Bone abscess formation c) Impingement syndrome d) Pathological fractures

Bone abscess formation Explanation: Bone abscess formation is a potential complication of osteomyelitis.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? a) Bone fracture b) Loss of estrogen c) Negative calcium balance d) Dowager's hump

Bone fracture Correct Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

Infectious Disease Assessment

• Health history • Physical Exam

Infectious Diarrhea Assessment

• History • Hydration status

18. A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A) Native Americans B) Caucasian Americans C) African Americans D) Asian Americans

C Feedback: African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.

20. A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, "My father died of prostate cancer at age 48." The nurse should instruct him on which of the following health promotion activities? A) The patient will need PSA levels drawn starting at age 55. B) The patient should have testing for presence of the CDH1 and STK11 genes. C) The patient should have PSA levels drawn regularly. D) The patient should limit alcohol use due to the risk of malignancy.

C Feedback: PSA screening is warranted by the patient's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.

3. A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort, burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient is exhibiting symptoms of what? A) Varicocele B) Epididymitis C) Prostatitis D) Hydrocele

C Feedback: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the spermatic cord.

2. An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem? A) Bowen's disease B) Peyronie's disease C) Phimosis D) Priapism

C Feedback: Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans. Bowen's disease is an in situ carcinoma of the penis. Peyronie's disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.

27. A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals "stoney" hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A) A normal finding B) A sign of early prostate cancer C) Evidence of a more advanced lesion D) Metastatic disease

C Feedback: Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is stony hard and fixed. This finding is not suggestive of metastatic disease.

26. A nursing student is learning how to perform sexual assessments using the PLISSIT model. According to this model, the student should begin an assessment by doing which of the following? A)Briefly teaching the patient about normal sexual physiology B)Assuring the patient that what he says will be confidential C)Asking the patient if he is willing to discuss sexual functioning D)Ensuring patient privacy

C Feedback: The PLISSIT (permission, limited information, specific suggestions, intensive therapy) model of sexual assessment and intervention may be used to provide a framework for nursing interventions. By beginning with the patient's permission, the nurse establishes a patient-centered focus.

14. A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? A) Urinary tract infection B) Chronic pain C) Permanent vascular damage D) Future erectile dysfunction

C Feedback: The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.

You are the nurse caring for a 91-year-old patient admitted to the hospital for a fall. The patient complains of urge incontinence and tells you he most often falls when he tries to get to the bathroom in his home. You identify the nursing diagnosis of risk for falls related to impaired mobility and urinary incontinence. The older adult's risk for falls is considered to be which of the following? A. The result of impaired cognitive functioning B. The accumulation of environmental hazards C. A geriatric syndrome D. An age-related health deficit

C. A geriatric syndrome A number of problems commonly experienced by the elderly are becoming recognized as geriatric syndromes. These conditions do not fit into discrete disease categories. Examples include frailty, delirium, falls, urinary incontinence, and pressure ulcers. Impaired cognitive functioning, environmental hazards in the home, and an age-related health deficit may all play a part in the episodes in this patient's life that led to falls, but they are not diagnoses and are, therefore, incorrect.

A gerontologic nurse is aware of the demographic changes that are occurring in the United States, and this affects the way that the nurse plans and provides care. Which of the following phenomena is currently undergoing the most rapid and profound change? A. More families are having to provide care for their aging members. B. Adult children find themselves participating in chronic disease management. C. A growing number of people live to a very old age. D. Elderly people are having more accidents, increasing the costs of health care.

C. A growing number of people live to a very old age. As the older population increases, the number of people who live to a very old age is dramatically increasing. The other options are all correct, but none is a factor that is most dramatically increasing in this age group.

An audit of a large, university medical center reveals that four patients in the hospital have current orders for restraints. You know that restraints are an intervention of last resort, and that it is inappropriate to apply restraints to which of the following patients? A. A postlaryngectomy patient who is attempting to pull out his tracheostomy tube B. A patient in hypovolemic shock trying to remove the dressing over his central venous catheter C. A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode D. A patient with depression who has just tried to commit suicide and whose medications are not achieving adequate symptom control

C. A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode Restraints should never be applied for staff convenience. The patient with urosepsis who is frequently ringing the call bell is requesting assistance to the bedside commode; this is appropriate behavior that will not result in patient harm. The other described situations could plausibly result in patient harm; therefore, it is more likely appropriate to apply restraints in these instances.

A recent nursing graduate is aware of the differences between nursing actions that are independent and nursing actions that are interdependent. A nurse performs an interdependent nursing intervention when performing which of the following actions? A. Auscultating a patient's apical heart rate during an admission assessment B. Providing mouth care to a patient who is unconscious following a cerebrovascular accident C. Administering an IV bolus of normal saline to a patient with hypotension D. Providing discharge teaching to a postsurgical patient about the rationale for a course of oral antibiotics

C. Administering an IV bolus of normal saline to a patient with hypotension Although many nursing actions are independent, others are interdependent, such as carrying out prescribed treatments, administering medications and therapies, and collaborating with other health care team members to accomplish specific, expected outcomes and to monitor and manage potential complications. Irrigating a wound, administering pain medication, and administering IV fluids are interdependent nursing actions and require a physician's order. An independent nursing action occurs when the nurse assesses a patient's heart rate, provides discharge education, or provides mouth care.

A home health nurse makes a home visit to a 90-year-old patient who has cardiovascular disease. During the visit the nurse observes that the patient has begun exhibiting subtle and unprecedented signs of confusion and agitation. What should the home health nurse do? A. Increase the frequency of the patient's home care. B. Have a family member check in on the patient in the evening. C. Arrange for the patient to see his primary care physician. D. Refer the patient to an adult day program.

C. Arrange for the patient to see his primary care physician. In more than half of the cases, sudden confusion and hallucinations are evident in multi-infarct dementia. This condition is also associated with cardiovascular disease. Having the patient's home care increased does not address the problem, neither does having a family member check on the patient in the evening. Referring the patient to an adult day program may be beneficial to the patient, but it does not address the acute problem the patient is having, the nurse should arrange for the patient to see his primary care physician.

Critical thinking and decision-making skills are essential parts of nursing in all venues. What are examples of the use of critical thinking in the venue of genetics-related nursing? Select all that apply. A. Notifying individuals and family members of the results of genetic testing B. Providing a written report on genetic testing to an insurance company C. Assessing and analyzing family history data for genetic risk factors D. Identifying individuals and families in need of referral for genetic testing E. Ensuring privacy and confidentiality of genetic information

C. Assessing and analyzing family history data for genetic risk factors D. Identifying individuals and families in need of referral for genetic testing E. Ensuring privacy and confidentiality of genetic information Nurses use critical thinking and decision-making skills in providing genetics-related nursing care when they assess and analyze family history data for genetic risk factors, identify those individuals and families in need of referral for genetic testing or counseling, and ensure the privacy and confidentiality of genetic information. Nurses who work in the venue of genetics-related nursing do not notify family members of the results of an individual's genetic testing, and they do not provide written reports to insurance companies concerning the results of genetic testing.

A patient has been diagnosed with small-cell lung cancer. He has met with the oncologist and is now weighing the relative risks and benefits of chemotherapy and radiotherapy as his treatment. This patient is demonstrating which ethical principle in making his decision? A. Beneficence B. Confidentiality C. Autonomy D. Justice

C. Autonomy Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that cases should be treated equitably.

The presence of a gerontologic advanced practice nurse in a long-term care facility has proved beneficial to both the patients and the larger community in which they live. Nurses in this advanced practice role have been shown to cause what outcome? A. Greater interaction between younger adults and older adults occurs. B. The elderly recover more quickly from acute illnesses. C. Less deterioration takes place in the overall health of patients. D. The elderly are happier in long-term care facilities than at home.

C. Less deterioration takes place in the overall health of patients. The use of advanced practice nurses who have been educated in geriatric nursing concepts has proved to be very effective when dealing with the complex care needs of an older patient. When best practices are used and current scientific knowledge applied to clinical problems, significantly less deterioration occurs in the overall health of aging patients. This does not necessarily mean that patients are happier in long-term care than at home, that they recover more quickly from acute illnesses, or greater interaction occurs between younger and older adults.

The nurse, in collaboration with the patient's family, is determining priorities related to the care of the patient. The nurse explains that it is important to consider the urgency of specific problems when setting priorities. What provides the best framework for prioritizing patient problems? A. Availability of hospital resources B. Family member statements C. Maslow's hierarchy of needs D. The nurse's skill set

C. Maslow's hierarchy of needs Maslow's hierarchy of needs provides a useful framework for prioritizing problems, with the first level given to meeting physical needs of the patient. Availability of hospital resources, family member statements, and nursing skill do not provide a framework for prioritization of patient problems, though each may be considered.

A patient has had a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. You are aware that the damage occurred where? A. Endocardium B. Pericardium C. Myocardium D. Visceral pericardium

C. Myocardium The myocardium is the layer of the heart responsible for the pumping action.

An 83-year-old woman was diagnosed with Alzheimer's disease 2 years ago and the disease has progressed at an increasing pace in recent months. The patient has lost 16 pounds over the past 3 months, leading to a nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements. What intervention should the nurse include in this patient's plan of care? A. Offer the patient rewards for finishing all the food on her tray. B. Offer the patient bland, low-salt foods to limit offensiveness. C. Offer the patient only one food item at a time to promote focused eating. D. Arrange for insertion of a gastrostomy tube and initiate enteral feeding.

C. Offer the patient only one food item at a time to promote focused eating. To avoid any "playing" with food, one dish should be offered at a time. Foods should be familiar and appealing, not bland. Tube feeding is not likely necessary at this time and a reward system is unlikely to be beneficial.

Your patient has been admitted for a liver biopsy because the physician believes the patient may have liver cancer. The family has told both you and the physician that if the patient is terminal, the family does not want the patient to know. The biopsy results are positive for an aggressive form of liver cancer and the patient asks you repeatedly what the results of the biopsy show. What strategy can you use to give ethical care to this patient? A. Obtain the results of the biopsy and provide them to the patient. B. Tell the patient that only the physician knows the results of the biopsy. C. Promptly communicate the patient's request for information to the family and the physician. D. Tell the patient that the biopsy results are not back yet in order temporarily to appease him.

C. Promptly communicate the patient's request for information to the family and the physician. Strategies nurses could consider include the following: not lying to the patient, providing all information related to nursing procedures and diagnoses, and communicating the patient's requests for information to the family and physician. Ethically, you cannot tell the patient the results of the biopsy and you cannot lie to the patient.

A nurse has been providing ethical care for many years and is aware of the need to maintain the ethical principle of nonmaleficence. Which of the following actions would be considered a contradiction of this principle? A. Discussing a DNR order with a terminally ill patient B. Assisting a semi-independent patient with ADLs C. Refusing to administer pain medication as ordered D. Providing more care for one patient than for another

C. Refusing to administer pain medication as ordered The duty not to inflict as well as prevent and remove harm is termed nonmaleficence. Discussing a DNR order with a terminally ill patient and assisting a patient with ADLs would not be considered contradictions to the nurse's duty of nonmaleficence. Some patients justifiably require more care than others.

A terminally ill patient you are caring for is complaining of pain. The physician has ordered a large dose of intravenous opioids by continuous infusion. You know that one of the adverse effects of this medicine is respiratory depression. When you assess your patient's respiratory status, you find that the rate has decreased from 16 breaths per minute to 10 breaths per minute. What action should you take? A. Decrease the rate of IV infusion. B. Stimulate the patient in order to increase respiratory rate. C. Report the decreased respiratory rate to the physician. D. Allow the patient to rest comfortably.

C. Report the decreased respiratory rate to the physician. End-of life issues that often involve ethical dilemmas include pain control, "do not resuscitate" orders, life-support measures, and administration of food and fluids. The risk of respiratory depression is not the intent of the action of pain control. Respiratory depression should not be used as an excuse to withhold pain medication for a terminally ill patient. The patient's respiratory status should be carefully monitored and any changes should be reported to the physician.

After a sudden decline in cognition, a 77-year-old man who has been diagnosed with vascular dementia is receiving care in his home. To reduce this man's risk of future infarcts, what action should the nurse most strongly encourage? A. Activity limitation and falls reduction efforts B. Adequate nutrition and fluid intake C. Rigorous control of the patient's blood pressure and serum lipid levels D. Use of mobility aids to promote independence

C. Rigorous control of the patient's blood pressure and serum lipid levels Because vascular dementia is associated with hypertension and cardiovascular disease, risk factors (e.g., hypercholesterolemia, history of smoking, diabetes) are similar. Prevention and management are also similar. Therefore, measures to decrease blood pressure and lower cholesterol levels may prevent future infarcts. Activity limitation is unnecessary and infarcts are not prevented by nutrition or the use of mobility aids.

During discussion with the patient and the patient's husband, you discover that the patient has a living will. How does the presence of a living will influence the patient's care? A. The patient is legally unable to refuse basic life support. B. The physician can override the patient's desires for treatment if desires are not evidence-based. C. The patient may nullify the living will during her hospitalization if she chooses to do so. D. Power-of-attorney may change while the patient is hospitalized.

C. The patient may nullify the living will during her hospitalization if she chooses to do so. Because living wills are often written when the person is in good health, it is not unusual for the patient to nullify the living will during illness. A living will does not make a patient legally unable to refuse basic life support. The physician may disagree with the patient's wishes, but he or she is ethically bound to carry out those wishes. A power-of-attorney is not synonymous with a living will.

The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding? A. This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B. Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury. C. This is an accurate indicator of myocardial injury. D. This result indicates muscle injury, but does not specify the source.

C. This is an accurate indicator of myocardial injury. Troponin I, which is specific to cardiac muscle, is elevated within hours after myocardial injury. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.

A patient with migraines does not know whether she is receiving a placebo for pain management or the new drug that is undergoing clinical trials. Upon discussing the patient's distress, it becomes evident to the nurse that the patient did not fully understand the informed consent document that she signed. Which ethical principle is most likely involved in this situation? A. Sanctity of life B. Confidentiality C. Veracity D. Fidelity

C. Veracity Telling the truth (veracity) is one of the basic principles of our culture. Three ethical dilemmas in clinical practice that can directly conflict with this principle are the use of placebos (nonactive substances used for treatment), not revealing a diagnosis to a patient, and revealing a diagnosis to persons other than the patient with the diagnosis. All involve the issue of trust, which is an essential element in the nurse-patient relationship. Sanctity of life is the perspective that life is the highest good. Confidentiality deals with privacy of the patient. Fidelity is promise-keeping and the duty to be faithful to one's commitments.

S/S of Scleraderma

CREST Calcinosis Raynaud's phenomenon (constriction of blood vessels) Esophageal dysfunction (acid reflux) Sclerodactyly (thickening and tightening of skin) Telangiectasias (dilation of capillaries causing skin redness)

Which of the following inhibits bone resorption and promotes bone formation? a) Parathyroid hormone b) Corticosteroids c) Estrogen d) Calcitonin

Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: a) Impingement syndrome b) Carpal tunnel syndrome c) Dupuytren's contracture d) Morton's neuroma

Carpal tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome.

Which group is at the greatest risk for osteoporosis? a) African American women b) Men c) Caucasian women d) Asian women

Caucasian women Explanation: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

The nurse is assisting with the application of a cast. What will the nurse expect to be done first?

Cleaning the skin surface.

A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this client's care, what desired outcome should the nurse identify? Client takes medication as prescribed and reports any adverse effects. Client's BP remains consistently below 140/90 mm Hg. Client denies signs and symptoms of hypertensive urgency. Client is able to describe modifiable risk factors for hypertension.

Client takes medication as prescribed and reports any adverse effects.

PAD Clinical Manifestations and Assessment/Diagnostic

Clinical Manifestations ~!Hallmark sign is intermittent claudication described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest ~As the disease progresses may have decreased ability to walk and pain at rest Assessment/Diagnostic ~A sensation of coldness or numbness in the extremities, skin, and nail changes, bruits (different kinds of blood flow), decreased peripheral pulses ~Exam peripheral pulses ~May use CW Doppler and ABI's (ankle brachial inspection- testing RN DOES NOT DO) treadmill testing for claudication, duplex ultrasonography

A client was playing softball and dislocated four fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?

Closed reduction

A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse?

Collects sputum for culture and sensitivity

COVID-19

Combination of transmission-based precautions, increased PPE use, enhanced cleaning, adjusted visiitor policies

Chain of Infection

Complete chain necessary for infection to occur • susceptible host • causative organism • reservoir of available organisms • portal of exit from reservoir • mode of transmission from reservoir to host • mode of enery into susceptible host

Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?

Compound

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do?

Cut a cast window.

A client has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the client and will implement a program of health education. What is the nurse's priority action? A. Ensure that the client understands the basic pathophysiology of diabetes. B. Identify the client's body mass index. C. Teach the client "survival skills" for diabetes. D. Assess the client's readiness to learn.

D

Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply.

Mucus secretions block airways. Overinflated alveoli impair gas exchange. Inflamed airways obstruct airflow.

A nurse is caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer?

Cough or change in chronic cough

A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations?

Cromolyn sodium

Which medication is contraindicated in acute asthma exacerbations?

Cromolyn sodium

Which would be consistent as a component of self-care activities for the client with a cast?

Cushion rough edges of the cast with tape

Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. With ACE inhibitors, assess for bradycardia. Beta-blockers may cause sedation. Direct vasodilators may cause headache and tachycardia. Cough is a common side effect of adrenergic inhibitors. With thiazide diuretics, monitor serum potassium concentration.

Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentration.

36. A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient? A) Apply a cold compress to the pubic area. B) Notify the urologist promptly. C) Irrigate the catheter with 30 to 50 mL of normal saline aS ordered. D) Administer a smooth-muscle relaxant as ordered.

D Feedback: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.

8. A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? A) The patient should not be in contact with the baby after delivery. B) The patient's treatment poses no risk to his daughter or her infant. C) The patient's brachytherapy may be contraindicated for safety reasons. D) The patient should avoid close contact with his daughter for 2 months.

D Feedback: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.

7. A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A) Fowler's position B) Prone position C) Supine position D) Lithotomy position

D Feedback: Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowler's position.

9. A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention? A) Hypertension B) Peripheral edema C) Tachycardia and other dysrhythmias D) Increased blood urea nitrogen (BUN)

D Feedback: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur with chronic urinary retention and large residual volumes.

37. A patient confides to the nurse that he cannot engage in sexual activity. The patient is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does the nurse know will be ordered for this patient to assess his sexual functioning? A) Sperm count B) Ejaculation capacity tests C) Engorgement tests D) Nocturnal penile tumescence tests

D Feedback: Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor changes in penile circumference during sleep using various methods to determine number, duration, rigidity, and circumference of penile erections; the results help identify whether the erectile dysfunction is caused by physiologic and/or psychological factors. A sperm count would be done if the patient was complaining of infertility. Ejaculation capacity tests and engorgement tests are not applicable for assessment in this circumstance.

39. A patient has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The patient's interdisciplinary plan of care should prioritize which of the following interventions? A) Penile implant B) PDE-5 inhibitors C) Physical therapy D) Psychotherapy

D Feedback: Patients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Because of the absence of an organic cause, medications and penile implants are not first-line treatments. Physical therapy is not normally effective in the treatment of ED.

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do?

Discuss the complications that the client may experience if there is lack of cooperation with the care plan.

During report, a nurse finds that she has been assigned to care for a patient admitted with an opportunistic infection secondary to AIDS. The nurse informs the clinical nurse leader that she is refusing to care for him because he has AIDS. The nurse has an obligation to this patient under which legal premise? A. Good Samaritan Act B. Nursing Interventions Classification (NIC) C. Patient Self-Determination Act D. ANA Code of Ethics

D. ANA Code of Ethics The ethical obligation to care for all patients is clearly identified in the first statement of the ANA Code of Ethics for Nurses. The Good Samaritan Act relates to lay people helping others in need. The NIC is a standardized classification of nursing treatment that includes independent and collaborative interventions. The Patient Self-Determination Act encourages people to prepare advance directives in which they indicate their wishes concerning the degree of supportive care to be provided if they become incapacitated.

You are the nurse caring for an elderly patient who is being treated for community-acquired pneumonia. Since the time of admission, the patient has been disoriented and agitated to varying degrees. Appropriate referrals were made and the patient was subsequently diagnosed with dementia. What nursing diagnosis should the nurse prioritize when planning this patient's care? A. Social isolation related to dementia B. Hopelessness related to dementia C. Risk for infection related to dementia D. Acute confusion related to dementia

D. Acute confusion related to dementia Acute confusion is a priority problem in patients with dementia, and it is an immediate threat to their health and safety. Hopelessness and social isolation are plausible problems, but the patient's cognition is a priority. The patient's risk for infection is not directly influenced by dementia.

Nurses and members of other health disciplines at a state's public health division are planning programs for the next 5 years. The group has made the decision to focus on diseases that are experiencing the sharpest increases in their contributions to the overall death rate in the state. This team should plan health promotion and disease prevention activities to address what health problem? A. Stroke B. Cancer C. Respiratory infections D. Alzheimer's disease

D. Alzheimer's disease In the past 60 years, overall deaths, and specifically, deaths from heart disease, have declined. Recently, deaths from cancer and cerebrovascular disease have declined. However, deaths from Alzheimer's disease have risen more than 50% between 1999 and 2007.

You are following the care plan that was created for a patient newly admitted to your unit. Which of the following aspects of the care plan would be considered a nursing implementation? A. The patient will express an understanding of her diagnosis. B. The patient appears diaphoretic. C. The patient is at risk for aspiration. D. Ambulate the patient twice per day with partial assistance.

D. Ambulate the patient twice per day with partial assistance. Implementation refers to carrying out the plan of nursing care. The other listed options exemplify goals, assessment findings, and diagnoses.

You are caring for an 82-year-old man who was recently admitted to the geriatric medical unit in which you work. Since admission, he has spoken frequently of becoming a burden to his children and "staying afloat" financially. When planning this patient's care, you should recognize his heightened risk of what nursing diagnosis? A. Disturbed thought processes B. Impaired social interaction C. Decisional conflict D. Anxiety

D. Anxiety Economic concerns and fear of becoming a burden to families often lead to high anxiety in older people. There is no clear indication that the patient has disturbed thought processes, impaired social interaction, or decisional conflict.

The physician has recommended an amniocentesis for an 18-year-old primiparous woman. The patient is 34 weeks' gestation and does not want this procedure. The physician is insistent the patient have the procedure. The physician arranges for the amniocentesis to be performed. The nurse should recognize that the physician is in violation of what ethical principle? A. Veracity B. Beneficence C. Nonmaleficence D. Autonomy

D. Autonomy The principle of autonomy specifies that individuals have the ability to make a choice free from external constraints. The physician's actions in this case violate this principle. This action may or may not violate the principle of beneficence. Veracity centers on truth-telling and nonmaleficence is avoiding the infliction of harm.

A gerontologic nurse is basing the therapeutic programs at a long-term care facility on Miller's Functional Consequences Theory. To actualize this theory of aging, the nurse should prioritize what task? A. Attempting to control age-related physiological changes B. Lowering expectations for recovery from acute and chronic illnesses C. Helping older adults accept the inevitability of death D. Differentiating between age-related changes and modifiable risk factors

D. Differentiating between age-related changes and modifiable risk factors The Functional Consequences Theory requires the nurse to differentiate between normal, irreversible age-related changes and modifiable risk factors. This theory does not emphasize lowering expectations, controlling age-related changes, or helping adults accept the inevitability of death.

A nurse has been using the nursing process as a framework for planning and providing patient care. What action would the nurse do during the evaluation phase of the nursing process? A. Have a patient provide input on the quality of care received. B. Remove a patient's surgical staples on the scheduled postoperative day. C. Provide information on a follow-up appointment for a postoperative patient. D. Document a patient's improved air entry with incentive spirometric use.

D. Document a patient's improved air entry with incentive spirometric use. During the evaluation phase of the nursing process, the nurse determines the patient's response to nursing interventions. An example of this is when the nurse documents whether the patient's spirometry use has improved his or her condition. A patient does not do the evaluation. Removing staples and providing information on follow-up appointments are interventions, not evaluations.

A gerontologic nurse is overseeing the care that is provided in a large, long-term care facility. The nurse is educating staff about the significant threat posed by influenza in older, frail adults. What action should the nurse prioritize to reduce the incidence and prevalence of influenza in the facility? A. Teach staff how to administer prophylactic antiviral medications effectively. B. Ensure that residents receive a high-calorie, high-protein diet during the winter. C. Make arrangements for residents to limit social interaction during winter months. D. Ensure that residents receive influenza vaccinations in the fall of each year.

D. Ensure that residents receive influenza vaccinations in the fall of each year. The influenza and the pneumococcal vaccinations lower the risks of hospitalization and death in elderly people. The influenza vaccine, which is prepared yearly to adjust for the specific immunologic characteristics of the influenza viruses at that time, should be administered annually in autumn. Prophylactic antiviral medications are not used. Limiting social interaction is not required in most instances. Nutrition enhances immune response, but this is not specific to influenza prevention.

A patient admitted with right leg thrombophlebitis is to be discharged from an acute-care facility. Following treatment with a heparin infusion, the nurse notes that the patient's leg is pain-free, without redness or edema. Which step of the nursing process does this reflect? A. Diagnosis B. Analysis C. Implementation D. Evaluation

D. Evaluation The nursing actions described constitute evaluation of the expected outcomes. The findings show that the expected outcomes have been achieved. Analysis consists of considering assessment information to derive the appropriate nursing diagnosis. Implementation is the phase of the nursing process where the nurse puts the care plan into action. This nurse's actions do not constitute diagnosis.

The nursing instructor is explaining critical thinking to a class of first-semester nursing students. When promoting critical thinking skills in these students, the instructor should encourage them to do which of the following actions? A. Disregard input from people who do not have to make the particular decision. B. Set aside all prejudices and personal experiences when making decisions. C. Weigh each of the potential negative outcomes in a situation. D. Examine and analyze all available information.

D. Examine and analyze all available information. Critical thinking involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas. A full disregard of one's own experiences is not possible. Critical thinking does not denote a focus on potential negative outcomes. Input from others is a valuable resource that should not be ignored.

An elderly patient has come in to the clinic for her twice-yearly physical. The patient tells the nurse that she is generally enjoying good health, but that she has been having occasional episodes of constipation over the past 6 months. What intervention should the nurse first suggest? A. Reduce the amount of stress she currently experiences. B. Increase carbohydrate intake and reduce protein intake. C. Take herbal laxatives, such as senna, each night at bedtime. D. Increase daily intake of water.

D. Increase daily intake of water. Constipation is a common problem in older adults and increasing fluid intake is an appropriate early intervention. This should likely be attempted prior to recommending senna or other laxatives. Stress reduction is unlikely to wholly resolve the problem and there is no need to increase carbohydrate intake and reduce protein intake.

The nurse is providing care for a patient with chronic obstructive pulmonary disease (COPD). The nurse's most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thinking is determining the significance of data that have been gathered. What characteristic of critical thinking is used in determining the best response to this assessment finding? A. Extrapolation B. Inference C. Characterization D. Interpretation

D. Interpretation Nurses use interpretation to determine the significance of data that are gathered. This specific process is not described as extrapolation, inference, or characterization.

A nurse is planning discharge teaching for an 80-year-old patient with mild short-term memory loss. The discharge teaching will include how to perform basic wound care for the venous ulcer on his lower leg. When planning the necessary health education for this patient, what should the nurse plan to do? A. Set long-term goals with the patient. B. Provide a list of useful Web sites to supplement learning. C. Keep visual cues to a minimum to enhance the patient's focus. D. Keep teaching periods short.

D. Keep teaching periods short. To assist the elderly patient with short-term memory loss, the nurse should keep teaching periods short, provide glare-free lighting, link new information with familiar information, use visual and auditory cues, and set short-term goals with the patient. The patient may or may not be open to the use of online resources.

A care conference has been organized for a patient with complex medical and psychosocial needs. When applying the principles of critical thinking to this patient's care planning, the nurse should most exemplify what characteristic? A. Willingness to observe behaviors B. A desire to utilize the nursing scope of practice fully C. An ability to base decisions on what has happened in the past D. Openness to various viewpoints

D. Openness to various viewpoints Willingness and openness to various viewpoints are inherent in critical thinking; these allow the nurse to reflect on the current situation. An emphasis on the past, willingness to observe behaviors, and a desire to utilize the nursing scope of practice fully are not central characteristics of critical thinkers.

The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence? A. SA node to bundle of His to AV node to Purkinje fibers B. SA node to AV node to Purkinje fibers to bundle of His C. SA node to bundle of His to Purkinje fibers to AV node D. SA node to AV node to bundle of His to Purkinje fibers

D. SA node to AV node to bundle of His to Purkinje fibers The normal electrophysiological conduction route is SA node to AV node to bundle of HIS to Purkinje fibers.

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

The home health nurse is making an initial home visit to a 76-year-old widower. The patient takes multiple medications for the treatment of varied chronic health problems. The patient states that he has also begun taking some herbal remedies. What should the nurse be sure to include in the patient's teaching? A. Herbal remedies are consistent with holistic health care. B. Herbal remedies are often cheaper than prescribed medication. C. It is safest to avoid the use of herbal remedies. D. There is a need to inform his physician and pharmacist about the herbal remedies.

D. There is a need to inform his physician and pharmacist about the herbal remedies. Herbal remedies combined with prescribed medications can lead to interactions that may be toxic. Patients should notify the physician and pharmacist of any herbal remedies they are using. Even though herbal remedies are considered holistic, this is not something that is necessary to include in the patient's teaching. Herbal remedies may be cheaper than prescribed medicine, but this is still not something that is necessary to include in the patient's teaching. For most people, it is not necessary to wholly avoid herbal remedies.

A nurse is admitting a new patient to the medical unit. During the initial nursing assessment, the nurse has asked many supplementary open-ended questions while gathering information about the new patient. What is the nurse achieving through this approach? A. Interpreting what the patient has said B. Evaluating what the patient has said C. Assessing what the patient has said D. Validating what the patient has said

D. Validating what the patient has said Critical thinkers validate the information presented to make sure that it is accurate (not just supposition or opinion), that it makes sense, and that it is based on fact and evidence. The nurse is not interpreting, evaluating, or assessing the information the patient has given.

The nurse admits a patient to an oncology unit that is a site for a study on the efficacy of a new chemotherapeutic drug. The patient knows that placebos are going to be used for some participants in the study but does not know that he is receiving a placebo. When is it ethically acceptable to use placebos? A. Whenever the potential benefits of a study are applicable to the larger population B. When the patient is unaware of it and it is deemed unlikely that it would cause harm C. Whenever the placebo replaces an active drug D. When the patient knows placebos are being used and is involved in the decision-making process

D. When the patient knows placebos are being used and is involved in the decision-making process Placebos may be used in experimental research in which a patient is involved in the decision-making process and is aware that placebos are being used in the treatment regimen. Placebos may not ethically be used solely when there is a potential benefit, when the patient is unaware, or when a placebo replaces an active drug.

The nurse is caring for an 82 year old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult? A. Decreased left ventricular ejection time B. Decreased connective tissue in the SA and AV nodes and bundle branches C. Thinning and flaccidity of the cardiac values D. Widening of the aorta

D. Widening of the aorta Changes in cardiac structure and function are clearly observable in the aging heart. Aging results in decreased elasticity and widening of the aorta, thickening and rigidity of the cardiac valves, increased connective tissue in the SA and AV nodes and bundle branches, and an increased left ventricular ejection time (prolonged systole).

A student nurse has been assigned to provide basic care for a 58-year-old man with a diagnosis of AIDS-related pneumonia. The student tells the instructor that she is unwilling to care for this patient. What key component of critical thinking is most likely missing from this student's practice? A. Compliance with direction B. Respect for authority C. Analyzing information and situations D. Withholding judgment

D. Withholding judgment Key components of critical thinking behavior are withholding judgment and being open to options and explanations from one patient to another in similar circumstances. The other listed options are incorrect because they are not components of critical thinking.

The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.)

Decreases hypoxemia Sustains positive end expiratory pressure (PEEP) Decreases patient anxiety

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles.

Decreases the production of neurotransmitters that constrict peripheral arterioles.

The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care?

Develop an alternate method of communication.

A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client?

Developing a list of people with whom the client has had contact

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? a) Wrist-hand junction b) Proximal humerus c) Femur-hip area d) Distal femur around the knee

Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites.

A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? dizziness persistent cough blurred vision tremor

Dizziness

Wound drains, inserted during the laryngectomy, stay in place until what criteria are met?

Drainage is <30 mL/day for 2 consecutive days.

What is the reason for chest tubes after thoracic surgery?

Draining secretions, air, and blood from the thoracic cavity is necessary.

Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require?

Emotional support

A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder?

Emphysema

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care?

Encouraging increased fluid intake

A client has been diagnosed as being prehypertensive. What should the nurse encourage this client to do to aid in preventing a progression to a hypertensive state? Avoid excessive potassium intake. Exercise on a regular basis. Eat less protein and more vegetables. Limit morning activity.

Exercise on a regular basis.

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client

Exhales hard and fast with a single blow

Which exposure accounts for most cases of COPD?

Exposure to tobacco smoke

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following? a) Hallux valgus b) Bunion c) Hammer toe d) Mallet toe

Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

Scleraderma

Hardening of the skin Creates mask like appearance with rigid mouth

A client with secondary hypertension has come into the clinic for a routine check-up. When comparing this client's diagnosis to primary hypertension, the nurse recognizes that secondary hypertension: has a specific cause. has a more gradual onset than primary hypertension. does not normally cause target organ damage. does not normally respond to antihypertensive drug therapy. TAKE ANOTHER QUIZ

Has a specific cause

The nurse is providing care for a client with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen? Screen the client for visual disturbances regularly. Have the client participate in monitoring his or her own BP. Emphasize the dire health outcomes associated with inadequate BP control. Encourage the client to lose weight and exercise regularly.

Have the client participate in monitoring her or her own BP.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

The nurse is obtaining a health history from a client on an annual physical exam. Which documentation should be brought to the physician's attention?

Hoarseness for 2 weeks

A nurse takes the initial history of a patient who is being examined for cancer of the larynx. Select the sign that is considered an early clinical indicator.

Hoarseness of more than 2 week's duration

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems?

Hypercapnia, hypoventilation, and hypoxemia

The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? The BP is always higher in a hypertensive emergency. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. Hypertensive urgency is treated with rest and benzodiazepines to lower BP. Hypertensive emergencies are associated with evidence of target organ damage.

Hypertensive emergencies are associated with evidence of target organ damage

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? Hypertensive emergency Hypertensive urgency Primary hypertension Secondary hypertension

Hypertensive emergency

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Hypovolemic shock

Asthma is cause by which type of response?

IgE-mediated

Arteriosclerosis and Atherosclerosis Nursing Management

Improve peripheral arterial circulation ~Positioning ~Walking/exercise Promoting Vasodilation and Preventing Vascular Compression ~Application of warmth-hot water bottle or heating pad may be applied to the abdomen causing vasodilation of the lower extremities ~Don't use nicotine products Relive Pain Maintain Tissue Integrity ~Healing avoid trauma, nutrition

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

Inadequate immobilization

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?

Incomplete

Interventions for patients with Sjogren's syndrome

Increase fluid intake Pain management Lubrication for mucosa (eyes, vaginal canal, mouth)

A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects?

Ineffective coping related to anxiety

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk?

Infection

The nurse is caring for a client who underwent a laryngectomy. Which intervention will the nurse initially complete in an effort to meet the client's nutritional needs?

Initiate enteral feedings.

A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first?

Initiate oxygen therapy.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? a) Initiating weight-bearing exercise routines b) Stopping estrogen therapy c) Taking a 300-mg calcium supplement to meet dietary guidelines d) Living a sedentary lifestyle to reduce the incidence of injury

Initiating weight-bearing exercise routines Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

Which intervention should the nurse implement with the client who has undergone a hip replacement?

Instruct the client to avoid internal rotation of the leg.

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? Administer I.V. fluids as ordered. Administer an isosorbide as ordered. Insert an indwelling urinary catheter as ordered. Instruct the client to sit for several minutes before standing.

Instruct the client to sit for several minutes before standing.

The nurse is assessing a client new to the clinic. Records brought to the clinic show that the client's hypertension has not improved. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? Progressive target organ damage Possibility of medication interactions Lack of adherence to prescribed drug therapy Possible heavy alcohol use or use of recreational drugs

Lack of adherence to prescribed drug therapy

The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal? Less than 140/90 mm Hg Less than 130/90 mm Hg Less than 129/89 mm Hg Less than 120/80 mm Hg

Less than 120/80 mm Hg

Problems caused by Rheumatic disease

Limitations in mobility Pain and fatigue Altered self-image Sleep disturbances Systemic effects

The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? Lowering and controlling the blood pressure without adverse effects and without undue cost Making sure that the patient adheres to the therapeutic medication regimen Instructing the patient to enter a weight loss program and begin an exercise regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

Lowering and controlling the blood pressure without adverse effects and without undue cost

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess?

Lung sounds

PE Manifestations/Assessments

Manifestations ~Dyspnea (difficulty breathing) ~Chest pain ~Anxiety, fear, apprehension (appending doom feeling) ~Tachycardia (high BP) ~Cough ~Diaphoresis (sweating) ~Hemoptysis (coughing up blood) Assessment ~Chest x-ray ~ECG ~Pulse ox ~ABG's ~D-dimer ~Pulmonary arteriogram or V/Q scan

DVT Medical/Nursing Management

Medical ~Preventing thrombus from growing and fragmenting ~Pharmacologic therapy- Heparin and Warfarin ~Cannot dissolve a thrombus that has already formed ~May need to combine anticoagulation with endovascular management ~Endovascular management- Done when contraindications for anticoagulation therapy, danger of PE is extreme, or permanent damage is highly likely Nursing ~Educate on watching for signs of excessive bruising, gum bleeding, bloody stool ~Monitor lab values for anticoagulation therapy- PTT (partial thromboplastin time), PT (Prothrombin time), INR (International normalized ratio- Therapeutic range 2-3.5!!!), ACT (activated clotting time), Hemoglobin and hematocrit, platelet, fibrinogen levels ~Monitor for complications- Bleeding, thrombocytopenia (low platelet levels), drug interactions (herbals) ~Reduce discomfort- Elevate, providing compression therapy, analgesics ~Positioning the body and promoting exercise ~Home care

C. Difficile

Most common cause of HAIs

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.

Which of the following is a metabolic bone disease that is characterized by inadequate mineralization of bone? a) Osteomalacia b) Osteomyelitis c) Osteoarthritis d) Osteoporosis

Osteomalacia Explanation: Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from extension of soft tissue infection, direct bone contamination, or hematogenous spread. Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.

Fibromyalgia

Pain and fatigue

A patient has had a laryngectomy and was able to retain his airway, with no difficulty swallowing. There is no split of thyroid cartilage. The nurse would record this type of laryngectomy as which of the following?

Partial laryngectomy

A patient is diagnosed as being in the early stage of laryngeal cancer of the glottis with only 1 vocal cord involved. For what type of surgical intervention will the nurse plan to provide education?

Partial laryngectomy

Deep Vein Thrombosis Pathophysiology/Manifestations

Pathophysiology ~Formation may frequently accompany phlebitis (inflimation/infection) ~Can occur in any vein but more commonly in the lower extremities ~Deep veins of the thighs or calf Manifestations ~Deep veins- Edema, swelling of the extremity, affected extremity may feel warmer than unaffected extremity, tenderness ~Superficial veins- Pain or tenderness, redness, warmth ~SCD, Moving, Walking- Used to help prevent DVT

Transmission-Based Precautions

Patients with known infectious diseases spread by airborne, droplet, contact routes

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. What should the nurse integrate into the management of this client's hypertension? Ensure that the client receives a larger initial dose of antihypertensive medication due to impaired absorption. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. Recognize that an older adult is less likely to adhere to the medication regimen than a younger client. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion.

The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? a) Monitor vital signs every 4 hours. b) Administer pain medication per client request. c) Examine surgical dressing every hour. d) Perform neuromuscular assessment every hour.

Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical.

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? Postural hypertension and resulting injury Rebound hypertension Sexual dysfunction Postural hypotension and resulting injury

Postural hypertension and resulting injury

A 70-year-old client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? a) Promoting range-of-motion (ROM) exercises b) Promoting weight-bearing exercises c) Maintaining protein levels d) Maintaining vitamin levels

Promoting weight-bearing exercises Explanation: When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.

A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? Reduce the blood pressure by 20% to 25% within the first hour of treatment. Reduce the blood pressure to about 140/80 mm Hg. Rapidly reduce the blood pressure so the client will not suffer a stroke. Reduce the blood pressure by 50% within the first hour of treatment.

Reduce the blood pressure by 20% to 25% within the first hour of treatment.

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? Renal failure Right ventricular hypertrophy Glaucoma Anemia

Renal failure

A male client is to have an amputation. He is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client? a) Reduced urine output b) Signs of nausea and vomiting c) Occurrence of allergic reactions d) Signs of sepsis

Signs of sepsis Explanation: If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency. Monitoring for signs of nausea and vomiting, occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client.

Polymyalgia Rheumatica (Giant Cell Arteritis)

Speckles of necrosis (especially in the mouth) Jaw + neck pain

Ankylosing Spondylitis

Spinal column shortening + inflammation

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?

Sputum and a productive cough

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a) Wound irrigation b) Wound packing c) Surgical debridement d) Vitamin supplements

Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

A client comes to the walk-in clinic complaining of frequent headaches. While assessing the client's vital signs, the nurse notes the BP is 161/101 mm Hg. How would this client's BP be defined? Elevated Normal Stage 1 hypertensive Stage 2 hypertensive

Stage 2 hypertensive

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? a) Proteus vulgaris b) Escherichia coli c) Psuedomonas aeruginosa d) Staphylococcus aureus

Staphylococcus aureus Explanation: S. aureus causes over 50% of bone infections. Other organisms include P. vulgaris and P. aeruginosa, as well as E. coli.

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. The incidence and prevalence of hypertension increase with age. Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

The incidence and prevalence of hypertension increase with age.

Hemodynamic Resistance

The most important factor that determines resistance in the vascular system is the vessel radius. Small changes in vessel radius lead to large changes in resistance. Veins dilate = fight-or-fight

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

Using a Venturi mask to deliver oxygen as ordered

DVT Complications

Valvular destruction: •Chronic venous insufficiency •Increased venous pressure •Varicosities •Venous ulcers Venous obstruction: •Edema •Fluid stasis •Increased distal pressure •Venous gangrene

Most cases of acute pharyngitis are caused by which of the following?

Viral infection

Norovirus

Virus associated with outbreaks in long-term care facilities and cruise ships

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy?

Vitamin B6

A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet? a) Green vegetables b) Red meat c) Bananas d) Vitamin D-fortified milk

Vitamin D-fortified milk Explanation: The nurse should advise the patient to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Decrease the intake of vitamin A and D b) Walk or perform weight-bearing exercises outdoors c) Increase fiber in the diet d) Reduce stress

Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation.

A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan?

Wearing a disposable particulate respirator that fits snugly around the face

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene?

Weights hanging and touching the floor

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted

Which of the following diagnostics confirms Paget's disease? a) Blood calcium level b) X-ray c) Bone scan d) Bone biopsy

X-ray Explanation: X-rays confirm the diagnosis of Paget's disease. Local areas of demineralization and bone overgrowth produce characteristic mosaic patterns and irregularities. Bone scans demonstrate the extent of the disease. A bone biopsy may aid in the differential diagnosis.

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should:

instruct the client to drink at least 2 L of fluid daily.

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for:

atelectasis

There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?

avascular necrosis

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?

contusion

Adiposopathy

dysfunction of adipose tissue that causes chronic inflammation and disease uPromotes development of metabolic, biomechanical, & psychosocial diseases & disorders uRelease biochemical mediators that cause chronic inflammatory changes - lead to heart disease, hypertension, diabetes type II

A blood pressure (BP) of 140/90 mm Hg is considered to be normal. prehypertension. hypertension. a hypertensive emergency.

hypertension

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply. hypertension diabetes obesity lowered triglyceride levels active lifestyle family history of early cardiovascular events

hypertension diabetes obesity family history of early cardiovascular events

Which nursing diagnosis is most likely for a client who has just undergone a total laryngectomy?

impaired verbal communication

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes

implementing measures to clear pulmonary secretions.

The nurse is reviewing the diet of a client who has been diagnosed with hypertension. The nurse recommends reducing or avoiding caffeine because caffeine: increases the heart rate and causes vasoconstriction. reduces the heart rate and leads to a coronary artery disease. reduces the heart rate and causes low blood pressure. increases the heart rate and causes angina.

increases the heart rate and causes vasoconstriction.

pt undergoing bariatric surgery

uDeficient knowledge about the dietary limitations during the immediate preoperative and postoperative phases uAnxiety related to impending surgery uAcute pain related to surgical procedure uRisk for deficient fluid volume related to nausea, gastric irritation, and pain uRisk for infection related to anastomotic leak uImbalanced nutrition: less than body requirements related to dietary restrictions uDisturbed body image related to body changes from bariatric surgery uRisk for constipation and/or diarrhea related to gastric irritation and surgical changes in anatomic structures from bariatric surgery

Gastric restrictive surgery

uExamples: Gastric Banding Procedure, Sleeve Gastrectomy uReduce volume capacity of stomach, absorption maintained uRisk: Erosion of band into stomach

Diet

uExcessive caloric intake uHigh-fat and high-cholesterol - Fast food uTrans fatty acids - Fried foods, processed foods, margarine

skin integrity and body mechanics

uHigh risk for pressure ulcers - Assess for pressure ulcers uSpecialty bariatric equipment u

coronary artery disease (CAD)

uHigh-fat, high-cholesterol diet contributes to blockages in the coronary arteries of the heart

Obese, older adults

uHigher risk for falls & mobility impairments uPossible increase in cognitive dysfunction uMore likely to end up in nursing homes uEncourage weight reduction, improved nutrition, possible candidate for weight loss surgery

Diabetes mellitus type 2

uKidney, cardiovascular, peripheral vascular, and eye issues uImpaired wound healing, increased risk of infection

Unbalanced low energy diets

uLow carbohydrate diets uControversial - Examples: Keto diet, Atkins diet uKetosis - a state where the body burns fat for energy uRisks - "Keto flu", diarrhea, ketoacidosis, loss of lean muscle mass, kidney issues

mechanics of ventilation and circulation

uMaintain in low Fowler position to maximize chest expansion uContinuous pulse oximetry uSupplemental oxygen uCPAP

intragastic balloon therapy

uORBERA or ReShape uEndoscopic placement of saline-filled balloon uRemains in place for 3 to 6 months uAdverse effects: N and V, balloon rupture causing obstruction

respiratory issues

uObstructive sleep apnea, Obesity Hypoventilation Syndrome (Pickwickian Syndrome), Asthma

height and weight to determine BMI

uOverweight = BMI 25 to 29.9 uObese = BMI exceeding 30 uSevere/extreme obese = BMI exceeding 40

very low calorie diets

uProtein-sparing modified fast - provides protein in limited calories. Rapid weight loss, preserves lean body mass uLiquid formula diet - 33-70g protein/day uMust be monitored by health care team, vitamin and mineral supplements uMost regain lost weight

Nursing Care of the Patient Undergoing Bariatric Surgery: Planning and Goals

uRelief of pain uMaintenance of homeostatic fluid balance uPrevention of infection/anastomotic leak uAdherence to diet/adequate nutritional status uKnowledge about vitamin supplements uNeed for lifelong follow-up uAchievement of positive body image uMaintain normal bowel habits

bariatric surgery

uResults in weight loss of 10% to 35% body weight within 2 years uImprovement in comorbid conditions uSelection by multidisciplinary team uSelection criteria - BMI of 30 for patients with comorbid conditions uSurgery is performed only after nonsurgical methods have failed

drug therapy

uSome prescribed medications can cause weight gain when taken for a long time. uCorticosteroids, Estrogens, NSAIDS, Antihypertensives, Antidepressants, Psychoactive drugs, Antiepileptics, some oral antidiabetic meds

pharmacokinetics and pharmacodynamics

uUnderstand that some drugs have enhanced effects while others have diminished effects with patients with obesity uRequire less IV norepinephrine uRequire more opioid for pain relief

Nursing Management

uUnderstand the effects of obesity uMechanics of ventilation and circulation uPharmacokinetics and pharmacodynamics uSkin integrity Body mechanics and mobility

Central and peripheral circulatory compromise

uUse appropriate size BP cuff uMonitor for DVT

preoperative care

ueducation and counseling uRisks and benefits of surgery uComplications uPostsurgical outcomes uDietary changes uLifelong follow-up Lab testing

Novelty Diets

ugrapefruit diet, juice diet, cookie diet uBelieve certain foods speed metabolism or oxidize body fat uNutritionally inadequate

aging

ulean skeletal muscle mass decreases, adipose tissue increases - metabolism drops

Varicose Veins Prevention and Medical/Nursing Management

~ ~Prevention (is key) ~Avoid activities that cause venous stasis (wearing socks that are too tight at the top or that leave marks on the skin, crossing the legs at the thighs, and sitting or standing for long periods) ~Elevate the legs 3-6 inches higher than heart level ~Walk for several minutes of every hour to promote circulation and 1 or 2 miles each day if no contraindications ~Wear graduated compression stockings ~Overweight patients should be encouraged to begin weight loss ~Thermal ablation Medical ~Microphlebectomy ~Sclerotherapy ~Ligation and Stripping Nursing ~Promoting comfort and understanding ~Promoting home, community-based, transitional care

Leg Ulcers

~An excavation of the skin surface that occurs when inflamed necrotic tissue sloughs off Pathophysiology ~Inadequate exchange of oxygen and other nutrients in the tissue ~When cellular metabolism cannot maintain energy balance, cell death (necrosis) results ~Severity depends on extent and duration ~Comes with comorbidities

Arterial Disorders

~Cause ischemia (restricted blood supply) and tissue necrosis ~May occur because of chronically progressive pathologic changes to the arterial vasculature (ex-Atherosclerotic changes) or due to an acute loss of blood flow to tissues (ex-aneurysm rupture) Arteriosclerosis and Atherosclerosis Peripheral Arterial Occlusive Disease Upper Extremity Arterial Occlusive Disease Aortoiliac Disease Arterial Embolism and Arterial Thrombosis Raynaud's Phenomenon and other Acrosyndromes

Other Diagnostic Evaluations and Nursing Implications

~Computed Tomography Scanning ~Angiography ~Magnetic Resonance Angiography ~Contrast Phlebography (Venography) ~Lymphoscintigraphy On procedures includes education on process, special dyes to be used and after procedure instructions

Arteriosclerosis and Atherosclerosis Pathophysiology

~Direct results-narrowing (stenosis) of the lumen, obstruction by thrombosis, aneurysm, ulceration and rupture ~Indirect results-malnutrition and the subsequent fibrosis of the organs that the sclerotic arteries supply with blood ~All actively functioning tissue cells require an abundant supply of nutrients and oxygen and are sensitive to any reduction in the supply of these nutrients ~Ischemic necrosis can occur if blood supply is reduced ~Collateral circulation (unintended redirected blood flow) ~Two types- Fatty streaks and Fibrous plaque

Adequate Perfusion

~Ensures oxygenation and nourishment of body tissues, and it depends in part on a properly functioning cardiovascular system ~Depends on the efficiency of the heart as a pump, the patency (how open) and responsiveness (the sending back) of the blood vessels, and the adequacy of circulating blood volume

Raynaud's Disease

~Intermittent arterial vasocclusion, usually of the fingertips or toes ~This phenomenon is associated with other underlying disease such as scleroderma Manifestations ~Sudden vasoconstriction results in color changes, numbness, tingling, and burning pain Triggered by ~Cold and Stress ~Vasoconstriction ~Not permanent ~Ineffective circulation

Lymphatic Disorders

~Lymphangitis- Inflammation or infection of the lymphatic channels ~Lymphadenitis- Inflammation or infection of the lymph nodes ~Lymphedema- Tissues swelling related to obstruction of lymphatic flow. Primary- Congenital Secondary- Acquired obstruction Medical ~Pharmacologic therapy ~Surgery Nursing ~Antibiotics ~Elevation ~Educate-avoid heating pads

Upper Extremity Arterial Disease

~Occurs less frequently than lower extremities Clinical Manifestations ~Arm fatigue, pain with exercise, inability to hold or grasp objects, difficulty driving, subclavian steal Assessment/Diagnostic ~Coolness and pallor in the affected extremity ~Decreased capillary refill ~Difference in bp of more than 20mm hg Nursing Management ~Check bp in both arms ~Postoperative -> Keep arm above heart level, protect from cold, no venipunctures, no tape or constrictive dressings

Peripheral Artery Disease

~Occurs most often in men, common cause of disability ~Age and onset ~Obstructive lesions are predominantly confined to segments of the arterial system extending from the aorta below the renal arteries to the popliteal artery

Aortoiliac Disease

~Patents with a stenosis or occlusion of the aortoiliac segment may be asymptomatic, may have pain in the buttocks, or low back discomfort when walking, especially if collateral circulation Medical Management ~Same for atherosclerotic PAD Nursing Management ~Pre-op and Post op assessments

Pathophysiology of the Vascular System

~Pump failure ~Alterations in blood (ex. thinner blood affects even good blood vessels) and lymphatic vessels ~Circulatory insufficiency of the extremities ~Aging produces changes in the walls of the blood vessels that affect the transport of oxygen and nutrients to the tissues

Venous Thromboembolism

~The blockage of a blood vessel by a thrombus carried through the bloodstream from its site of formation Pathophysiology ~Virchow triad- Endothelial change (caused by smoking), Venous stasis (immobility after surgery or sickness), Altered coagulation (caused by smoking) ~Trauma, anticoagulation medications, oral contraceptives, elevated CRP levels (inflammation), blood dyscrasias, pregnancy (because of increased blood flow)

Chronic Venous Insufficiency/Post thrombotic Syndrome

~Venous insufficiency results from obstruction of the venous valves in the legs or a reflux of blood through the valves Manifestations ~Chronic venous stasis resulting in edema ~Altered pigmentation ~Pain ~Stasis dermatitis- notice more in the evening and less in morning ~Develop stasis ulcers ~Can happen on its own or after a thrombus Management ~Prevent ulceration and reduce venous stasis ~Provide compression therapy- Stocking (placed correctly) Gerontologic considerations (educate) ~External compression ~Intermittent pneumatic compression devices

HAI Potential Organisms

• C. difficile • Methicillin-resistant S. aureus (MRSA) • Vancomycin-resistant organisms (VRE) • Multidrug-resistant organisms (MDROs) • Health care-associated bloodstream infections

Droplet Precautions

• Close contact with respiratory or pharyngeal secretions: influenza, meningococcus • Wear mask; door may remain open; transmission limited to close contact